Here is a list of Frequently Asked Questions of Case Management and, more specifically, Med NY Case Management. The answers to these questions will help to provide a more thorough understanding of case management services and how they can benefit your company.

Should you have additional questions that are not answered in these FAQs, please feel free to Request More Info by phone or e-mail.

A: The Case Management Society of America defines case management as a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services needed to meet a person’s health needs. The case manager uses communication and the resources available to promote quality, cost-effective outcomes.  Case managers make decisions and recommendations after reviewing all facets of care. Case Managers are the liaison between the healthcare provider and all involved parties. It is essential to have a case manager involved in order to assure that each facet of a case is given the attention required.

A: Case management can be traced back as early as the 1920’s when it was used to manage outpatient services for psychiatry patients.  In the 1930’s, case management migrated into public health nursing, and after WW II it was used to manage the care and needs of war veterans.

By the late 1970’s case managers worked in-house for property and casualty insurers.  About this same time, clinical nurses began collaborating with social workers on discharge planning needs.  In the 1980’s case management was used to coordinate services and provide discharge planning in outpatient care, home care, subacute care, and many community service agencies. 

A:  Case management requires interaction with all relevant components of the heath care system: patient, family, physician, payor, employer, and the entire treatment team.  Case management must encompass six essential components to be effective or beneficial.  These components are:

• Assessment: This first step in the case management process involves a full evaluation of the patient’s injury, disease, or illness.  The patient’s full medical history must be gathered and assessed, as well as information and recommendations from other health care professionals providing care.

• Planning: Based on the information gathered and assessed, the case manager works with the patient, employer, and the patient’s physician to develop a treatment plan.  In some cases, this will include the use of a critical pathway, which outlines specific indicators of progress which correspond to anticipated outcomes based on the provider’s treatment plan.

• Implementation:  The case manager is typically responsible for implementing the care plan and is the point person for the patients, their families, providers, and employer.

• Coordination: This step involves pulling together all of the resources required to care for the patient and meet the expected outcomes.  The case manager also schedules appointments to facilitate the process.

• Monitoring:  Once the patient’s care plan has been put into place, the case manager continues to monitor his or her progress, with the goal being to return the patient back to his or her activities of daily life as much as possible prior to the onset of injury or disease.

• Evaluation:  The case manager will consistently evaluate the patient’s progress.  One key step in evaluation is devising strategies to prevent recurrence, which can include measures from simply creating a safer home and work environment to those as drastic as changing the patient’s lifestyle.

A: Employers are attracted to the case management concept because of the highly specialized skills case managers possess in balancing cost and quality.  They can potentially save employers thousands of dollars in health care expenses every year.

Case management provides information to payors regarding health care needs and services that achieve cost effective, outcome-based results. This leads to timely coverage decisions and provisions of care that can reduce treatment duration and prevent future complications.

Case managers negotiate with providers and payors, obtaining diverse services with controlled costs.

Case managers facilitate the exchange of employment information to the physician so return-to-work issues are made from an informed perspective. The case manager works with the employer to obtain a job description, physical demands, information on alternative work positions, and job accommodations.  The case manager also provides necessary information to the employer regarding expected time frames for return-to-work.  If appropriate a full ergonomic worksite evaluation is performed.

Case managers will consistently evaluate the patient’s progress.  One key step in evaluation is devising strategies to prevent recurrence.  This will help create a safer home and work environment.

Case managers work with employers to develop the most effective return-to-work plan. Case managers have the ability to recognize potential problems before they occur, which can lead to a more favorable outcome.

A: Case managers assist patients in obtaining the most appropriate, highest quality, and cost effective care.

Focuses on the full spectrum of patient needs rather than just those of concern to a particular provider or payor, thus identifying comprehensive needs.

Provides information about resources available to patients, whether public or private and how to appropriately access these resources.

Case managers work with patients throughout their entire contact with the health care system, promoting coordinated care, minimizing fragmentation, and facilitating appropriate referral to alternate or supplemental providers.  The personalized service provided by case management makes the employee’s recovery process more efficient. 

Focuses on outcomes of care, aiding providers in selecting treatments aimed toward a common goal. Case managers assist employees in evaluating their personnel circumstances and developing realistic rehabilitation plans.

The case manager can make referrals or tells the patient how to self-refer.

If a patient needs a service for which he or she is not covered, the case manager explores alternative sources of care.

Provides assessment of the patient’s and family’s understanding of the diagnosis and prognosis as well as their expectations.