How Case Management Reform Is Reshaping Healthcare

Managing the complex and often competing pressures of health care delivery in the USA puts a substantial burden on case management practitioners and executives, across the full spectrum of healthcare settings in which they are engaged. Their ability to develop and integrate programs and procedures that balance these competing pressures underpins the ability of the evolving healthcare system to meet its goals.

Meeting the fundamental goals of healthcare

The objectives of the ‘Quadruple Aim’ provide a critical framework for optimizing the operation of healthcare delivery systems. The three initial primary goals are:

  1. Improving the individual patient care experience
  2. Improving population health
  3. Reducing per capita cost of care 

These are the essential elements of an effective and self-sustaining business model of healthcare that will function well in the present and the future.

The latter 4th aim sets out a culture of equity, quality, and safety for patients and practitioners alike in the medical workplace as a prerequisite to success in achieving the other three goals.

Case management leadership is key

Increasingly, the achievement of these goals relies on the many inter-related roles and responsibilities of case management professionals. These can include:

  • Patient assessments that incorporate physical, behavioral, and social determinants of patient health into care planning protocols
  • Coordinating patient resources, clinical services, and community support programs to maximize cost-effective outcomes
  • Facilitating open, consistent, and constructive communication between patients and caregivers, and among the Interprofessional team members
  • Enabling patient engagement in self-managed care, self-advocacy, and ensuring safe transitions through phases of care
  • Maintaining, analyzing, and reporting health records for hospitals, healthcare management organizations, insurers, and regulatory bodies

This partial list gives a strong indication of the crucial part that effective case management plays in the overall operation of adequate health care. From nurse leaders to hospital executives, case management expertise and awareness is at the heart of improving patient care and population health, while enhancing efficiency and reducing costs.

Interim leaders with case management certification

At NHS Solutions, many of our interim department director and other temporary senior staff positions are based in part on case management experience and certification. If this describes you and your background, or that of someone you know and recommend, let’s get in touch and talk about the challenges and opportunities that await.

Accessibility Toolbar