Case management and quality of care for diabetic patients.
Increasing clinical demand for medical services in an environment of limited financial resources to reimburse for such services has lead to the evolution of case management processes. They may be defined as processes that help achieve the best possible clinical outcome for a patient at a cost that represents the best value to the patient and benefit plan. The most responsive and sensitive execution of a case management process is one that includes a high level of physician peer review. This type of case management may enhance the quality of care rendered to diabetic and other patients. Care that is neither necessary nor appropriate cannot be considered quality, no matter who renders it, nor how good the outcome. A case management process that focuses on medical necessity and seeks flexibility from patients, physicians, providers, and payors can help to maintain appropriate high-quality care with costs that, over time, deliver value to all participants in the process. The execution of, and the elements contained within, a clinically sensitive case management process is briefly discussed.
Korn
A M
AM
William M. Mercer, Inc., Chicago, IL 60606.
D000574:American Medical Association; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy; D006801:Humans; D008329:Managed Care Programs / Q000592:standards*; D011785:Quality Assurance, Health Care; D014481:United States