Case management is the collective process of assessing, advocacy, facilitation and planning for services and opportunities to achieve an individual’s needs through utilization of resources and communication for promotion of outcomes that are cost-effective (Arnold, 2007). The main purpose of case management is to meet health needs of a client. Case management is considered a social model in that the case manager and client/patient work together to improve the areas of the client’s life that are affected by health problem. The social model involves achieving well-being and improving health of the client by addressing medical and biological factors in tandem with environmental and social determinants of the client’s health.
Case management has been used for diverse purposes both in the social services sector and health sector (Marie, 2007). Case management is mostly applied in the management of severe health conditions, treating people suffering from mental health disorders and other disabilities, managing injuries and insurances, caring for the aged, employment and managed care programs, marginalized populations in school, and youth welfare. Case managers are normally people experienced in the relevant profession, for instance, health professionals, allied health workers and workers in the social and service industries (Case Management Society of America, 2008).
The best practices of case management exhaustively cover the monitoring, evaluation, planning and outcome phases of the management plan (Powell and Tahan, 2008). Performance standards have to be set to increase efficiency of the case managers’ performance. The case manager is required to adhere to all legal requirements. Performance standards should spell out how each care manager is to achieve optimal performance within his area of work. Case managers are encouraged to participate in the researching, implementing programs and developing tools to enhance case management. The case management plan must address issues of cost-effective health care, safety and quality (Powell and Tahan, 2008).
The fundamental features of case management include: client privacy, confidentiality and privacy; information about risk and contractual arrangements; effective relationship building between the case manager and the patient; prolific negotiation skills; effective verbal and written communication; ability to pay proper attention to cultural competence; ability to analyze and use critical thinking; organization and planning skills; promotion of the client’s self-determination and autonomy; proper utilization of funds and knowledge about their source; special skills in the dynamics of human behavior; clinical standards and human care delivery (Case Management Society of America, 2011).
Case management can involve groups of clients or individual clients and is mostly applied in the population health models and disease management. Communication and cooperation between the case manager and the client are important elements in facilitating successful case management (Tahan et al., 2011). Case management standards are periodically revised so as to reflect the changing dynamics of a society. The total needs of the client including behavioral, medical, spiritual and psychosocial needs must be met. The main aim is to move an individual from being dependent to a point where he or she can take care of himself/ herself. The involvement of the caregiver and an individual must be maximized in the decision making process (Stokes, 2009). To increase efficiency, evidence-based guidelines must be used daily in the case management. If an individual is to be transferred from one caregiver or place then the transfer process must be timely, safe and the patient must be informed beforehand.
Client satisfaction and safety must be improved if the case management plan is to deliver its objectives successfully (Stokes, 2009). The client must be advised on the benefits of adhering to the case management plan, especially the medication aspect. Quality services must be coordinated effectively to ensure that the client’s specific needs are addressed in a cost-effective manner. The case manager plays very essential role, since he or she facilitates communication and interaction between the client, health team, community, payer, the client’s family and support system (Arnold, 2007).
Professional bodies across the world have established guiding principles to ensure that effective case management plans are formulated. The guidelines are set to guide care managers as they implement care management plans (Marie, 2007). Basically, when the client reaches the optimum level of well-being and all the parties involved are capable of functioning for the benefit. Case management achieves the client’s autonomy and well-being through effective communication, knowledge, information, facilitation of services, and identification of the required resources (Case Management Society of America, 2011). Case management succeeds in an environment where there is direct communication between the client, the case manager and other personnel members involved in health care provision. The most fundamental guideline in the case management is that individuals suffering from chronic illnesses and fatal injuries must be evaluated for case management. Care must be client-centered and holistic so that the health care system can steer resources towards recuperation of the client (Stokes, 2008). Case management focuses on the dual goals of achieving health for the patient as well as maintaining health of the client to the highest degree possible.
Health care must be provided efficiently and appropriately. The case manager must identify care options which are preferred by the client and which suit the client the most. This makes it possible for the client to adhere to the care management plan (Marie, 2007). Another guiding principle is that care management should be consolidated and be provided by one health provider as opposed to fragmentation where health care services are provided by multiple providers (Case management Society of America, 2008). The aim is to reduce costs while enhancing the clients’ well-being, safety and quality of life.
The guidelines require case managers to use a collaborative client-centered approach. They are also required to facilitate self-care and self-determination of an individual through sharing input during the decision making process (Powell and Tahan, 2008). Care managers must observe the principle of cultural competence by being aware about the differences between races, cultures, genders, ethnicities amongst other things and appreciating the diversity of their clients. Evidence-based care must be provided at all times. The case manager must have an adequate knowledge about science of behavioral change and integrate principles with the current health status of the client (Arnold, 2007). It is very important for the case management plan to be linked to community resources. Competence and professional excellence must be observed by case managers at all stages of the case management plan. The case management plan must comply with organizational, local, state and federal rules, laws and regulations at all time. The guidelines are targeted at ensuring stability, wellness and self-care of the clients.
Clinical pathways/protocols are used to improve outcomes by managing selected patients based on the pre-identified method (Tahan et al., 2011). The pathways are mostly used in cases related to the surgery, cardiology, orthopedics, neurosurgery, psychiatry, oncology, renal cases, endocrine cases, asthma, diabetes and lipid programs. The pathways are identified and developed based on the complexity of care and high volume diagnosis (Case Management Society of America, 2010). The pathways assist in coordination and conserving resources by ensuring that they are utilized appropriately. They also prevent the occurrence of errors since junior rookie doctors and nurses can use them for check-listing (Tahan et al., 2011). Evaluation of the patients is done on the basis of clinical complications, length of stay in the hospital and readmission.
An effective case management plan must have the objective of improving the outcome for patients. This is done by adhering to the set guidelines and evaluating the client’s acceptance and understanding of the proposed case management plan (Marie, 2007). The client must be willing to change and must be willing to support the caregiver in achieving behavioral change in health matters. The case management system must be expanded to include support system of the client, such as friends and relatives. It should involve all health care providers including community-based practitioners and facility-based practitioners such as nurses and pharmacists in order to provide holistic care for the patients.