Redesigning case management in managed care: an eclectic approach: from city to ranch.
Case management programs are a common approach to managing the quality and cost of services in managed care organizations. Once developed these programs may grow stagnate as the managed care member population grows and changes. This article presents a redesign project initiated by a managed care organization located in a rural Southwest region of the United States. Nursing theory and case management standards of practice form the basis of the redesign project and will be discussed. The case management model, including roles and responsibilities of staff, are presented. Results and future implications are identified.
Calhoun
Jean
J
Presbyterial Health Plan, Albuquerque NM 87125-7489, USA.
Casey
Paula
P
D019090:Case Management / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration* / Q000592:standards; D017146:Models, Organizational; D008962:Models, Theoretical; D009516:New Mexico; D009936:Organizational Innovation; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration*