Case Management in Managed Care
Case workers role has been influenced by managed care and new cost containment strategies which are creating competition and role conflict. Mental health care services theme has become an organized philosophy undergoing massive change. United States managed care leads in healthcare decisions, applying cost effectiveness, evaluation in reimbursement, pharmaceuticals, drug treatments, health maintenance organizations (HMO), pharmacy benefit management firms (PBMS) and operating hospitals. In this paper I will explore the evolving role of cost-effectiveness in manage care.
Since the 1800's, case management has been a factor in the United States healthcare system. Just as healthcare continues to evolve so has the function of care management. Care systems have several components; it has been described as a patient delivery system, a professional practice model or coordinating care. One thing that is certain is the fact that there is no clear definition of case management because of its elusiveness. (Case Management) Shipiro (1995) defined managed care as "any kind of health care services which are paid for, all or in part, by a third party, including any government entity. (Grabowski 1998)
The importance of clinical case managers have increased within the mental health field. Clinical case manager are typically licensed clinical social workers and psychologist responsible for making sure treatments are manageable. Coordinating various entities for patients as well as being the professional point of contact. Clinical case managers also oversee patient's benefits; these are just a few of the required duties provided. The clinical case workers are the medium between the providing facility and managed care company while also working with patients to ensure the benefits provided by the patients insurance is used appropriately. Case management and community treatment play an important role in managing mental health care services...
References: Grabowski, H. (1998, Fall). The role of Cost-Effectiveness Analysis in Managed-Care Decisions. Department of Economics, Duke University, 14(1), 15-24.
Cohen, J. A. (2003, January). Managed Care and the Evolving Role of the Clinical Social Worker in Mental Health. National Association of Social Workers, 48(1), 34-43.
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