Medical case management is a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals. It is a role frequently overseen by patient advocates.
It refers to the planning and coordination of health care services appropriate to achieve the goal of medical rehabilitation. Medical case management may include, but is not limited to, care assessment, including personal interview with the injured employee, and assistance in developing, implementing and coordinating a medical care plan with health care providers, as well as the employee and his/her family and evaluation of treatment results.
Medical case management requires the evaluation of a medical condition, developing and implementing a plan of care, coordinating medical resources, communicated teamcare needs to the individual, monitors an individual’s progress and promotes cost-effective care.
The term also has usage in the USA health care system, referring to the case management coordination in the managed care environment.
The case management model developed in the US was a response to the closure of large psychiatric hospitals (known as deinstitutionalisation) and initially for provision of services which enhances the quality of life without the need for direct patient care or contact. Clinical or therapeutic case management then developed as the need for the mental health professional to establish a therapeutic relationship and be actively involved in clinical care, often in this only the personal and interpersonal resources are utilized. The process involved can be cyclical because of its client-centered nature. According to the American Association on Mental Retardation (1994) “Case Management (service coordination) is an ongoing process that consists of the assessment of wants and needs, planning, locating and securing supports and services, monitoring and follow-along. The individual or family is the defining force of this service coordination process.”
A more active form of case management is present in assertive community treatment (or intensive case management), this provides a holistic and integrated approach in psychiatric case management with coordinated services that promote increased wellness for the management’s (homes or agencies) population. This form of management is a part of managed care systems and often falls in legal trouble for coerced care, others include health maintenance organizations, point-of-service plans, and preferred provider arrangements.