Care management: quelling the confusion. Case managers help clients access resources appropriate to their needs.
The vast number of available healthcare services can be confusing to those seeking care. Care managers can resolve these issues by helping the vulnerable and their families find and receive appropriate services. Care management is not limited to the elderly: Others with special needs also benefit from care management. Care managers integrate and coordinate services, providing a continuum between the client and the providers of acute, long-term, home-based, and community-based care. The care management model that most organizations adopt at first is the brokering model. In this model care managers identify the appropriate service package from resources in the community. In the service management model, the care manager authorizes the services provided within specified financial limits. The funding source influences what services he or she can recommend. Another model is managed care. The carrier of a high-risk group of clients or a group of enrollees in a certain healthcare program prospectively pays the organization providing care management. In the acute care setting, providers find the transition to care management challenging because they have been oriented to short, episodic care. These providers must adopt new protocols to be able to work with providers and programs within their own organization or at other organizations. In community-based care, care managers' goal is to help the client and family access appropriate services so the client can function independently within his or her home. Community-based referrals are from family members or agencies and infrequently follow an acute care hospitalization.
Westhoff
L J
LJ
Catholic Health Association, St. Louis.
D000208:Acute Disease; D000368:Aged; D002410:Catholicism; D002908:Chronic Disease; D003153:Community Health Services; D003266:Continuity of Patient Care / Q000458:organization & administration*; D006760:Hospitalization; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D008962:Models, Theoretical; D010347:Patient Care Planning / Q000458:organization & administration*; D014481:United States