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Case Management Programs and Quality of Care

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Are case management programs more concerned with reducing cost or improving the quality of care?

What are some limitations and strengths of a case management program?

Will case management programs become a medical program necessity in the future?

How important are gatekeepers to the case management process?

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Solution Summary

The case management programs and quality of care are examined.

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Case management is used in many different types of clinical or social settings, such as social
work or healthcare. Any organization that provides services to the public or a group within the
population may utilize case management. It is widely used in clinical settings, as a means of monitoring,
assessing, and measuring outcomes for practice (Howe, 2005). Outcomes can include measures of
satisfaction, quality of care, efficiency of services, and proficiency of healthcare providers.
OptumHealth (2012) recognizes the main objectives of case management as reducing costs while
improving quality of care. The organization also realizes that these objectives may not be compatible
with each other. However, they are compatible when improved quality of care leads to greater
efficiency, improved satisfaction of care, and better outcomes for patients. Higher levels of satisfaction
and better outcomes translate into fewer resources utilized to achieve the same health outcomes.
Therefore, when fewer resources are used to achieve the same goals, the patient care process becomes
more efficient, thus reducing costs . While improved quality of care may be a stated objective for
case management, ultimately the practice is a cost saving measure.

Like other monitoring programs within an organization, case management does have some
advantages and limitations. One of the limitations may be in lack of insight into the future care needs
of patients. Case ...

Solution provided by:
Beatrice Martino, MEd
Education
  • MEd, Jones International University
  • BSc, DeVry University
  • MPH, Walden University
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