Management History- Case Management Society of America, (2010). "Definitions of and History of Case Management in Health Care Settings." Cited in: http://www.cmsa.org/Default.aspx?tabid=104
Medical case management is part of the managed care technique within the American health care system. It is collaborative, and included planning, advocacy, and facilitation for particular clients through the case manager's network of resources. At its best it is multidisciplinary and cross functional, able to monitor and offer appropriate services and care to clients who are in need. At worst, it can be a difficult set of bureaucratic hurdles in which often the "squeaky" wheel is top of mind for care. The key for case management, however, is collaborative. In the United States, a CCM (Certified Case Manager) credential is available for health care providers licensed to practice within a multifaceted, and sometimes fragmented, health care system. To receive certification candidates must pass a rigorous examination, similar in content and difficulty to State Board exams for nurses. Within the system, case management focuses on four basic templates which are designed to deliver personalized services to patients in need: 1) Referral of new patients or clients new to area or care, 2) Specialized individual plan and delivery of care, 3) Continual evaluation of care plan -- regular adjustments, and 4) Evaluation of the overall program's effectiveness and appropriateness of care. Case management became necessary after the 1973 "Health Maintenance Organization Act," when medical and insurance professionals realized that in order to provide even adequate care personalized case management would be required. And, as the projected demographics of the nation showed an increasingly aging population, even more so in the ensuing decades.
Certification and Qualifications of Case Managers- Haley, J. (2007). "Experience Shown to Affect Communication Skills of Nurse Case Managers." Care Management Journals. 8 (2): 50+.
Case management certification is a robust program that goes beyond clinical healthcare and requires that the participant understand the voluminous amounts of interaction that must take place within the contemporary health care system. It is appropriate for Registered Nurses or RNs with a social work background. The CCM is complex enough than and LPN is not yet ready -- the CCM must be able to be licensed to assess and evaluate the health of clients, both in a clinical and chart-based system. Within the framework of case management, research shows that about 30% of time is spent on teaching the client to gain autonomy and responsibility in decision making for their own health care. Thus, not only is it essential that the CCM be medically trained, and then trained in insurance and multidisciplinary health care issues, but that they have exceptional communication skills. This study found, in fact, that the success of CCMs is directly linked to communication style and abilities -- in particular, the ability to provide a strong but professional advocacy role for the patient.
Acute Care Case Management Models -- Chernesky, R. And B. Grube. (2000). "Examining the HIV / AIDS Case Management Process." Health and Social Work. 25 (4): 243+.
The HIV / AIDS population is already a population at risk for a number of reasons: health issues, availability of pharmaceuticals, costs of care, access to care, inability to work, the social welfare system, and still vast misunderstanding and prejudices. In order to adequately assist this population with the basic aspects of daily living, regardless of disease diagnosis or prognosis, a robust an ongoing case management protocol is essential. These clients tend to present while in crisis, so if a protocol and rubric is already established, the quality of care is certainly increased. The critical place of the HIV / AIDS case manager is as a direct service hub, in which the relationships and networking abilities of the case manager are allowed to come to the forefront to aid this population base, and to increase the cross-functional understanding of said group as well. This educational aspect is…