Healthcare case management program

Understanding the Difference Between Case Management and Managed Care in Healthcare

Posted on by Mark Moran

I.      Introduction

The healthcare field is more complicated now, needing different ways to take care of patients and manage resources. Two important strategies used in this area are case management and managed care. While these two can sometimes overlap, they serve different roles. Case management focuses on coordinating care for individuals, looking at each patient’s specific needs and helping to provide customized interventions to improve health outcomes. On the other hand, managed care is a wider system aimed at controlling costs while making sure people have access to good healthcare services. This essay will outline the key differences between these two ideas, looking at how each is important in the overall healthcare system. By understanding these differences, healthcare workers and decision-makers can better handle the issues of providing effective care during times of quick change, which can lead to better patient satisfaction and more efficient systems.

Please also review AIHJCP’s Case Management Training and see if it meets your academic and professional goals

Please also review AIHCP and the American Academy of Case Management’s Healthcare Case Management Program

A.    Definition of Case Management

In healthcare, case management is about a complete and organized way to meet patient needs during their care journey. It includes assessing, planning, putting into action, and reviewing care plans that are personalized for each patient. This approach aims to create teamwork among healthcare workers, patients, and their families. It not only focuses on clinical treatments but also helps to deal with complicated healthcare systems, especially for high-risk groups (Arulkumaran et al., 2019). Additionally, good case management is crucial for reducing service delivery problems and tackling healthcare inequalities, especially in tough financial situations faced by organizations like the NHS, which is looking for new ways to provide care while using resources wisely (Kagioglou et al., 2012). In the end, case management is emphasized as a proactive strategy, which is different from the more reactive methods seen in managed care.

B.    Definition of Managed Care

Managed care is a way to make healthcare better and cheaper. It includes different methods to mix how healthcare is paid for and given, often putting a spotlight on preventing illness, managing long-term diseases, and making sure people can get necessary health services. By managing patient care well, managed care seeks to make sure that patients get the right services at the right times, which can help lower the number of unnecessary hospital visits or procedures. The success of managed care systems can be measured by how well they combine running costs efficiently with high-quality care. For example, a study looking at health plans for Medicaid beneficiaries shows big differences in care management results, like costs and how happy patients are (Michael H Bailit et al., 2011). Also, using digital tools, such as cloud computing for Electronic Health Records (EHR), is crucial for making sure that data quality improves the ongoing care that is key to effective managed care (Almutiry et al., 2013).

C.    Importance of Understanding the Differences

Understanding the differences between case management and managed care is important for improving healthcare delivery. Both models seek to improve patient outcomes and simplify services, but they operate in different ways. Case management is about personalized care coordination, focusing on the specific needs of patients through customized interventions and support, which enhances health and function. On the other hand, managed care is concerned with controlling costs and efficiency by managing provider networks and patient access to services. Merging these methods can enhance overall health value, but confusion often leads to inefficiencies. For example, studies show how informal communication can influence decision-making and crisis management in healthcare settings (Ackroyd S et al., 2014). Recognizing these differences can help improve collaboration between agencies and technology integration, making healthcare systems more adaptable and responsive (Hartswood et al., 2001).

II.  Historical Context

Managing case load and care of patients is a key part of healthcare and ensuring quality and progress of the patient

The past context of healthcare delivery systems has notably influenced how case management and managed care have developed. At first, healthcare was fragmented, and patients often moved through the system without any support to coordinate their care. This started to change with policies that aimed to make the system more efficient and accountable, helping to create managed care models that focused on controlling costs and integrating services. For example, the Patient Choice initiative in the UK changed how hospitals supplied services, forcing healthcare providers to meet new patient needs and face competition (Addicott R et al., 2011). At the same time, the rise of accountable care organizations (ACOs) showed a growing awareness of the need for coordinated care systems that align the interests of providers and payers (Aricca D Citters V et al., 2012). Understanding these historical changes is important because they clarify the reasons for today’s practices in case management and managed care in the healthcare field.

A.    Evolution of Case Management in Healthcare

The progress of case management in healthcare has been greatly influenced by the demand for better coordinated and tailored patient care. At first, case management was mainly about managing resources, but it has grown to include a broader way of thinking that takes into account social factors affecting health and the merging of community resources. Recent collaborations between healthcare groups and community organizations, shown by programs like the Partnership for Healthy Outcomes, highlight this change toward tackling health disparities and enhancing access to care by using resources and know-how from different fields (Miller E et al., 2017). Additionally, the creation of quality incentive programs has changed this development, leading case management practices to shift in ways that focus on improving quality and patient outcomes, aligning more closely with managed care goals (Jon B Christianson et al., 2007). This change underscores the need for all-encompassing care strategies that go beyond standard medical services.

B.    Development of Managed Care Models

The rise of managed care models has changed the healthcare delivery system, focusing on controlling costs and improving patient care coordination. These models were created to tackle the complexities of healthcare systems, especially for vulnerable groups like older adults who qualify for both Medicare and Medicaid. The issue of disjointed care in these populations often worsens health disparities and raises costs, as seen in over 200 partnerships aimed at improving health outcomes ((Miller E et al., 2017)). Additionally, the significant care needs of these individuals call for new service delivery methods; as a result, recent programs under the Affordable Care Act are working to better unify care for those eligible for both Medicare and Medicaid, leading to major opportunities in managed care models ((N/A, 2014)). With these changes, healthcare providers can more effectively implement important, patient-focused reforms.

C.    Key Legislation Influencing Both Practices

The difference between case management and managed care in health care is influenced by important laws that shape how they operate. Laws like the Affordable Care Act (ACA) have pushed for more integrated care, making managed care organizations focus on efficient use of resources while trying to improve patient results. Also, the Medicare Modernization Act has allowed case management to grow by encouraging personalized care plans that help manage chronic diseases better. These laws highlight the importance of measuring performance in health care systems; however, recent studies show that these measurements often do not have practical use for making strategic decisions, especially regarding long-term planning for health care estates (O’Brien et al., 2018). Moreover, increasing health care costs and large federal spending on programs like Medicare and Medicaid, which are expected to take up a big part of the federal budget, emphasize the immediate need for new policy ideas to ensure access while keeping fiscal responsibility in mind (Jenson et al., 2004).

III.             Core Functions and Objectives

In healthcare, it is important to understand case management and managed care to improve patient results and make services more efficient. Case management is about organizing resources and help that fit individual needs, so patients can handle the complicated healthcare system better. Managed care, on the other hand, looks to keep costs down but still provide quality care by managing how services are given within certain networks. The research shows that a connected system is important for providing complete care coordination across areas like healthcare, education, and family support, which is key to both models (Jeanne W McAllister et al., 2009). However, there are problems with measuring performance, as focusing too much on clinical delivery can affect long-term planning for healthcare facilities, which can lessen the effectiveness of both systems (O’Brien et al., 2018). Knowing these functions helps connect patient care and management methods better.

A.    Goals of Case Management

The aims of case management are numerous, focusing on improving patient results while providing effective care coordination. A key part of this is helping communication among healthcare providers so they can offer combined services that meet each patient’s individual needs. Good case management tries to stop unnecessary hospital stays by encouraging preventative health checks and education, thus matching care delivery with patients’ long-term health goals. Also, case managers have an important role in guiding patients through complicated healthcare systems, making sure they get the right resources and services, especially when technology can assist in decision-making (Austin et al., 2006). Yet, there are still issues, like the need for strong performance measurement systems that guide planning in healthcare organizations (O’Brien et al., 2018). By focusing on both patient-centered aims and organizational effectiveness, case management proves to be essential, setting it apart from managed care and ultimately improving healthcare delivery quality.

B.    Goals of Managed Care

In healthcare, managed care aims to improve service delivery and keep costs low. Its main goal is to manage healthcare expenses by using resources wisely and focusing on preventive care. This approach stresses the importance of coordination among providers, making sure patients get the right care according to set guidelines. Financial risk-sharing and building strong relationships among healthcare providers are essential, as shown by the idea that both economic and non-economic integration help manage hospital-physician relations effectively (Annemans et al., 2010). Additionally, managed care does not only seek to lower costs; it also encourages high-quality care, as healthcare professionals value specialized and well-coordinated education for better practices (Craig et al., 2008). In the end, managed care’s main goal is to improve patient results while keeping healthcare systems financially sound.

C.    Comparison of Service Delivery Approaches

The comparing of service delivery methods, mostly between case management and managed care, shows different ways to make healthcare better. Case management focuses on personal care coordination, where one case manager helps with each patient’s needs and resources. This type of support can greatly improve health results, particularly for at-risk groups like dual eligibles who deal with difficult medical and social issues (N/A, 2014). On the other hand, managed care systems aim at having a structured network of providers to reduce costs and improve healthcare efficiency, often due to budget limits, as seen in projects like North Carolina’s Medicaid reform, which aims to use limited resources wisely while helping access (Rice et al., 2017). Knowing these differences is important for creating better plans in healthcare delivery, especially as healthcare systems look to combine and coordinate care for different patient groups.

IV.            Roles and Responsibilities

In the changing field of healthcare, it is important to clearly define what case managers and managed care professionals do for better patient outcomes. Case management mainly means coordinating care, helping patients understand health services, and making sure they can access needed resources. On the other hand, managed care involves managing healthcare delivery systems to control costs and make services work better. Case managers need to know about community resources and be strong advocates for their patients, while managed care professionals focus on policy and financial management. Recently, there has been more recognition of the role of community health workers in this area, as shown by recent studies, which highlights their ability to help improve care delivery. However, these workers have challenges with being officially recognized, getting proper education, and finding sustainable funding, all of which are vital for maximizing their effectiveness in both case management and managed care settings (Devine et al., 2020)(Dower C et al., 2006).

Case Management plays a key role in healthcare. Please review AIHCP’s Case Management Training Program and see if it meets your academic goals

A.    Case Manager’s Role in Patient Care

In healthcare, case managers are important for helping patient care by making sure services work together and stay consistent. This job is especially key when dealing with complicated care situations, where patients have many health issues. By connecting healthcare providers and patients, case managers look at individual needs, create care plans, and fight for needed resources. Their work is vital in stopping breaks in treatment that could make a patient’s condition worse, which matches research showing changes in the hospital supply chain during policy changes to improve patient choices and care efficiency (Addicott R et al., 2011). Also, new initiatives like the Complex Care Management Program show how case management is changing to help with chronic conditions and provide tailored care, which is crucial for keeping quality in a competitive healthcare field (N/A, 2013). This blending of case management into patient care represents the move towards more patient-focused healthcare delivery.

B.    Managed Care Organization’s Role

Managed Care Organizations (MCOs) are important in changing how healthcare is delivered by focusing on lower costs and better care. MCOs want to lower health gaps and boost patient results by using preventive care and detailed case management. The focus on good communication that respects different cultures is very important since it helps make sure all groups get fair care that meets their needs. Research shows that when MCOs make cultural understanding a priority, they can better deal with differences in how health services are used and the quality of care provided ((Lurie et al., 2004)). In addition, effective models from different health systems show that working together can improve care coordination by using sophisticated data analysis and community relationships to enhance patient involvement and education ((Baquet et al., 2004)). In the end, the forward-thinking methods used by MCOs are key in managing the complicated nature of healthcare, setting their method apart from older case management practices.

C.    Interdisciplinary Collaboration in Both Models

Looking at the importance of teamwork in case management and managed care models, it is clear that working together is key for providing complete healthcare services. Case management depends a lot on the coordination of different healthcare workers to meet the complex needs of patients, which improves the overall care quality. In educational settings, clinical experiences that encourage teamwork help nursing students build their confidence in assessing and managing patients, preparing them for jobs in integrated healthcare environments (Mooy et al., 2004). Likewise, managed care focuses on collaboration among providers to make services smoother and ensure better outcomes for patients. A significant study showed that interdisciplinary palliative care courses improve students’ understanding of professional roles and enhance communication among team members, which ultimately helps patient care and interactions (Breakwell et al., 2012). This information highlights the need to promote teamwork in both models to improve healthcare effectiveness and patient satisfaction.

V.  Conclusion

Please also review AIHCP’s Case Management Program and see if it meets your academic and professional goals

In wrapping up the study of case management and managed care in healthcare, it is clear that both systems are important for improving patient outcomes, even though they use different methods. Case management is centered on the unique needs of patients, providing personalized support and coordination for complex medical issues. On the other hand, managed care focuses on cost savings and managing health for groups, often using standard procedures to make services more efficient and lower costs. When these methods work together, they can improve healthcare delivery. For example, insights gained from effective health programs, like those highlighted in the Synthesizing Lessons Learned and Identifying Future Research Opportunities conference, show how policy changes can make these systems better at dealing with long-term health problems and encouraging preventative care (Devine et al., 2020)(N/A, 2005). In the end, understanding how these systems differ not only explains their roles but also highlights the need for continued teamwork in the changing field of healthcare.

A.    Summary of Key Differences

In looking at the main differences between case management and managed care in healthcare, it is clear that both have important, but different roles in providing patient-focused services. Case management focuses on organizing care for individuals, making sure that patients get personalized help and support during their treatment, which is important for dealing with complex health problems. On the other hand, managed care is all about managing healthcare costs and keeping quality high through organized plans and provider networks, with the goal of being efficient in service delivery. Although both aim for better health results, they go about it in different ways: case management offers a more personal approach, while managed care is centered on efficiency and controlling costs. Grasping these differences is important for healthcare workers who want to use both systems well, as shown by the need for culturally aware communication in managed care organizations to tackle gaps in service delivery (Lurie et al., 2004). Additionally, looking at how managed care operates can reveal wider system issues that affect patient choices and access (Addicott R et al., 2011).

B.    Implications for Healthcare Professionals

The changing healthcare scene means that workers must adjust to the different roles set by case management and managed care, which are both important for providing patient-centered services. As shared care models become more common, healthcare workers need to deal with the challenges brought by these systems, which change the focus from hospital-based to community-based care. These changes can affect their duties and the standards of care they must maintain in different situations (Coleman et al., 2015). Moreover, the need for effective communication with different cultures is more important than ever, as tackling health gaps requires providers to connect well with various groups. By focusing on cultural understanding at different levels of an organization, healthcare workers can improve patient interactions and outcomes, which can enhance overall care quality (Lurie et al., 2004). Therefore, knowing these impacts is important for healthcare workers who want to meet both legal and ethical standards in a changing healthcare world.

C.    Future Trends in Case Management and Managed Care

As healthcare changes, trends in case management and managed care are becoming more linked, showing the need for a better approach to patient care. One main trend is the growth of technology-based solutions, like telehealth and data analysis, which help case managers watch patient progress from afar and tailor care plans more efficiently. Also, the move toward value-based care focuses on results rather than services provided, which pushes managed care organizations to work closely with case managers to make sure patients get the right help on time. Additionally, more attention on social factors affecting health is pushing case management to consider not just medical needs but also wider lifestyle and environmental issues that affect health results. These changes indicate a pivotal time when coordinated care methods will be crucial for enhancing patient experiences and improving healthcare delivery systems.

Please also review AIHCP’s Case Management Training.  The case management program is online and independent study and open to qualified healthcare and mental healthcare professionals who utilize case management.  The online program leads to a four year certification.

 

References:

  • Austin, T, Darlison, MW, Ingram, D, Kalra, et al. (2006). Towards an interoperable healthcare information infrastructure – working from the bottom up. https://core.ac.uk/download/1670855.pdf
  • O’Brien, Geraldine, Rodriguez-Labajos, Laura, Thomson, Craig (2018). Performance measurement for the strategic management of healthcare estates. https://core.ac.uk/download/293884853.pdf
  • Mooy, Cherie (2004). Nursing Students\u27 Self-Efficacy and Attitude: Examining the Influence ofthe Omaha System In Nurse Managed Centers. https://core.ac.uk/download/223074342.pdf
  • Breakwell, Susan, Faut Callahan, Margaret, MinJu, Kim, Phillips, et al. (2012). Clinical Observation Reflections from Students in an Interdisciplinary Palliative Care Course. https://core.ac.uk/download/213079311.pdf
  • Addicott R., Anderson J.C., Appleby J., Bryman A., Burge P., Christopher M., Christopher M., et al. (2011). Understanding the UK hospital supply chain in an era of patient choice. https://core.ac.uk/download/20089557.pdf
  • Aricca D. Van Citters, Bridget K. Larson, Elliott S. Fisher, Eugene C. Nelson, Frances M. Wu, Josette N. Gbemudu, Kathleen L. Carluzzo, et al. (2012). Four Health Care Organizations’ Efforts to Improve Patient Care and Reduce Costs. https://core.ac.uk/download/71358207.pdf
  • Michael H. Bailit, Michael J. McCue (2011). Assessing the Financial Health of Medicaid Managed Care Plans and the Quality of Patient Care They Provide. https://core.ac.uk/download/71357691.pdf
  • Almutiry, Omar, Alwabel, Abdulelah, Crowder, Richard, Walters, et al. (2013). Toward a framework for data quality in cloud-based health information system.
  • Coleman, B, Nicholls, JA, Patterson, DL, Potts, et al. (2015). Legal and professional implications of shared care: a case study in oral anticoagulation stroke prevention therapy.. https://core.ac.uk/download/29410962.pdf
  • Lurie, Nicole, Taylor, Stephanie L (2004). The role of culturally competent communication in reducing ethnic and racial healthcare disparities.. https://core.ac.uk/download/pdf/18491828.pdf
  • Jeanne W. McAllister, Jill Popp, Richard Antonelli (2009). Making Care Coordination a Critical Component of the Pediatric Health System: A Multidisciplinary Framework. https://core.ac.uk/download/71352885.pdf
  • Ackroyd S., Argyris C., Boisot M., Bruijn H., Castle S., Collingridge D., Collingridge D., et al. (2014). What lies beneath? The role of informal and hidden networks in the management of crises. https://core.ac.uk/download/16460010.pdf
  • Hartswood, Mark, Procter, Rob, Voss, Alex, Williams, et al. (2001). Pick-n-mix approaches to technology supply : XML as a standard “glue” linking universalised locals. https://core.ac.uk/download/9846402.pdf
  • Elise Miller, Laura Line, Trishna Nath (2017). Working Together Toward Better Health Outcomes. https://core.ac.uk/download/86445047.pdf
  • Jenson, Jennifer (2004). Health Care Spending: Context and Policy. https://core.ac.uk/download/5129505.pdf
  • Jon B. Christianson, Kim Sutherland, Sheila Leatherman (2007). Paying for Quality: Understanding and Assessing Physician Pay-for-Performance Initiatives. https://core.ac.uk/download/71346847.pdf
  • Baquet, Claudia R, Bengen-Seltzer, Barbara, Carter-Pokras, Olivia (2004). Healthcare disparities and models for change.. https://core.ac.uk/download/pdf/17192976.pdf
  • Annemans, Lieven, Gemmel, Paul, Trybou, Jeroen (2010). An integrative model of the management of hospital physician relationships. https://core.ac.uk/download/55730718.pdf
  • Craig, L.E., McAlpine, C.H., Smith, L.N., Weir, et al. (2008). Stroke education for healthcare professionals: making it fit for purpose. https://core.ac.uk/download/90007.pdf
  • Devine, Trish, Jordan, Joseph, Knoderer, Chad, McFarland, et al. (2020). The Value Driven Pharmacist: Basics of Access, Cost, and Quality 2nd Edition. https://core.ac.uk/download/287886562.pdf
  • Catherine Dower, Edward O’Neil, Melissa Knox, Vanessa Lindler (2006). Advancing Community Health Worker Practice and Utilization: The Focus on Financing. https://core.ac.uk/download/71345277.pdf
  • Rice, Allison, Richman, Barak D. (2017). N.C. Medicaid Reform: A Bipartisan Path Forward. https://core.ac.uk/download/84098969.pdf
  • Arulkumaran, Nishkantha, Connolly, Bronwen, Dark, Paul, Hopkins, et al. (2019). Synthesis of qualitative research studies regarding the factors surrounding UK critical care trial infrastructure. https://core.ac.uk/download/287582567.pdf
  • Kagioglou, M, Marshall-Ponting, AJ, Sapountzis, S, Smith, et al. (2012). Modelling and simulating unplanned and urgent healthcare: the contribution of scenarios of future healthcare systems.. 

Unequal Access and Disparity in Healthcare

Posted on by Dominick Flarey

The goal of the healthcare system is to grant equal access to the finest care for anyone but this is not the case and is a goal that has not been achieved.  Poorer demographic areas, minorities, and more rural areas all face less and equal access as richer and more urban areas.  Those with a bigger wallet or who live in a more wealthy and urban area have an incredible advantage over others.  This calls for a large call for sweeping reforms in healthcare and its delivery to the nation’s more vulnerable.  It calls for better laws, better healthcare programs and more healthcare facilities to meet the growing needs of the population.  These are many issues that Case Managers have to face with patients.

Not everyone has the same access to good healthcare. Please also review AIHCP’s Healthcare Case Management Program

 

The article, “What is health inequity?” by Jayne Leonard looks at the nature of health inequity and how it differs from the term healthcare inequality.  The article gives various examples of how these terms relate to the real world and what groups and areas face more challenges.  Leonard states,

“Health inequity refers to avoidable differences in health between different groups of people. These widespread differences are the result of unfair systems that negatively affect people’s living conditions, access to healthcare, and overall health status. Health inequity affects people from disadvantaged or historically oppressed groups most severely. However, it has a negative impact on everyone. This article will look at health inequity in more detail, explaining how it differs from health inequality and its impact.”

What is health inequity?. Jayne Leonard. May 16th, 2021. MedicalNewsToday.

To read the entire article, please click here

Commentary

Health disparities are a complex issue that has been a long-standing problem in healthcare. They arise from various social, economic, and environmental factors such as poverty, education, race, ethnicity, and geography. These disparities cause differences in access to healthcare, quality of care, and health outcomes. Health disparities have a significant impact on individuals and communities, leading to increased morbidity and mortality rates, reduced quality of life, and increased healthcare costs.  This type of unequal access is an issue for healthcare providers and case managers attempting to ensure their patients receive the best care.

Understanding the Causes of Health Disparities

As in most cases, poverty and poverty stricken areas play the largest role in healthcare inequity and disparity. Please also review AIHCP’s Case Management Program

 

Health disparities are caused by a combination of factors, including social determinants of health, access to healthcare, and individual behavior. Social determinants of health are the conditions in which people are born, grow, live, work, and age. These determinants include factors such as poverty, lack of education, poor housing conditions, and lack of access to healthy food options. Access to healthcare is another critical factor in health disparities. People who live in low-income areas or rural areas often lack access to quality healthcare services, resulting in poor health outcomes. Lastly, individual behavior such as smoking, alcohol consumption, and lack of physical activity can also contribute to health disparities.

The Impact of Health Disparities on Individuals and Society

The impact of health disparities is far-reaching and affects individuals and society as a whole. Individuals who experience health disparities are more likely to suffer from chronic diseases such as diabetes, heart disease, and cancer. They are also more likely to have shorter lifespans and experience higher mortality rates. Health disparities also have a significant economic impact on society. The cost of treating preventable diseases that arise from health disparities is estimated to be around $93 billion per year in the United States alone.

Examples of Health Disparities

Poverty and race play key roles in healthcare disparity

 

Health disparities exist across a range of health outcomes, including infant mortality rates, life expectancy, and chronic disease prevalence. For example, African American infants are twice as likely to die before their first birthday compared to white infants. Women of color are more likely to be diagnosed with advanced stages of breast cancer and are more likely to die from the disease than white women. Native Americans have a higher prevalence of diabetes and are more likely to die from the disease than any other racial or ethnic group.

The Cost of Health Disparities

Health disparities not only have a significant impact on individuals and society but also come at a high cost. The cost of treating preventable diseases that arise from health disparities is estimated to be around $93 billion per year in the United States alone. This cost includes direct medical costs, such as hospitalization and medication, as well as indirect costs, such as lost productivity and reduced quality of life.

Addressing Health Disparities through Policy and Advocacy

Addressing health disparities requires a multi-faceted approach that involves policy and advocacy. Policy solutions such as expanding access to healthcare, increasing funding for health education programs, and improving economic and social conditions can help reduce health disparities. Advocacy efforts can also play a critical role in addressing health disparities. Community-based organizations can advocate for policies that address the root causes of health disparities and work to educate the public about the importance of health equity.

The Role of Healthcare Providers in Reducing Health Disparities

Healthcare providers and case managers can play key roles in helping patients and people find equal access to care

 

Healthcare providers have a crucial role to play in reducing health disparities. Providers can work to ensure that all patients have access to quality healthcare services regardless of their race, ethnicity, or socioeconomic status. Providers can also work to address cultural and linguistic barriers that may prevent patients from accessing care. Additionally, providers can work to improve health literacy by providing patient education and resources that help patients better understand their health conditions.  Case Managers can also play a role within their healthcare facility in attempting to help individuals receive the care they need.

Community-Based Solutions for Reducing Health Disparities

Community-based solutions are another critical component of addressing health disparities. Community organizations can work to address the root causes of health disparities by providing education, resources, and support to individuals and families. These organizations can also work to improve access to healthcare services by providing transportation, language services, and other resources that help remove barriers to care. Community-based solutions are particularly effective in addressing health disparities in marginalized communities.

The Importance of Addressing Social Determinants of Health

Addressing social determinants of health is critical to reducing health disparities. Social determinants such as poverty, lack of education, and poor housing conditions have a significant impact on health outcomes. By addressing these determinants, we can help reduce health disparities and improve health outcomes. Strategies for addressing social determinants of health include increasing access to affordable housing, improving educational opportunities, and increasing economic opportunities.

Conclusion – Moving towards Health Equity

Health disparities are a complex issue that requires a multi-faceted approach to address. By understanding the causes and impact of health disparities, we can work to develop policies and programs that help reduce these disparities. Healthcare providers, community organizations, and policymakers all have a critical role to play in addressing health disparities. By working together, we can move towards health equity and ensure that all individuals have access to quality healthcare services and the opportunity to live healthy, fulfilling lives.

Please also review AIHCP’s Healthcare Case Management Program and see if it meets your academic and professional goals

 

As healthcare professionals, we have a responsibility to advocate for health equity and work towards reducing health disparities.  Healthcare professionals and healthcare case managers can work with providers and other aspects to help ensure everyone receives the healthcare and treatment they need.

Please also review AIHCP’s Healthcare Case Management Program and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified healthcare professionals seeking a four year certification as a case manager.

Additional Resources

“Reducing disparities in health care”. AMA. Access here

“Racial Inequities Persist in Health Care Despite Expanded Insurance”. Roni Caryn Rabin.  August 17th, 2021. New York Times. Access here

“Health Inequity in the Time of a Pandemic”. Madelyn Valu. October 9th, 2020. HIMSS. Access here

“Health Equity — Are We Finally on the Edge of a New Frontier?”. Michele Evans, MD. September 10th, 2020. The New England Journal of Medicine. Access here

Telehealth and Healthcare Case Management

Posted on by Dominick Flarey

Telehealth is here to stay.  While it was necessary during the pandemic and any future elements of it that may linger, the benefits of telehealth has found a more permanent place in modern medicine.  It will continue to play a large role in medical care.  It will also play a large role in affecting the Case Management and how patients meet recovery requirements.  It may be easier to keep tabs on patients and ensure they are following protocol through telehealth check ups that require less time.  A simple appointment of follow up care can be an easier way to manage patient care following procedure.

Telehealth has many benefits.  In particular, there are many benefits to better case management since telehealth can promote better follow up care and patient accountability.  Please also review AIHCP’s Healthcare Case Management Program

 

The article, “8 benefits of Telehealth” by Siemens Healthineers looks at the benefits of telehealth.  The article discusses 8 pertinent benefits of telehealth to healthcare.  Among the many are better patient outcomes which is essential in case management.  The flexibility, adherence of the patient and cost reduction all play key roles into cheaper healthcare in the future as well as better case management.  It is believed that telehealth is here to stay after the pandemic and that is a good thing.   The article states,

“The benefits of telehealth are striking, offering hospitals the chance to brand themselves as innovative and using cutting-edge technologically. And while the pandemic has pushed telehealth forward, its ability to provide a high level of medical care in numerous situations will make telehealth a permanent fixture in healthcare. Continuous improvements in technology and further simplifications of tedious processes support this evolution.”

“8 benefits of Telehealth”. Siemens Healthineers.  February 15th, 2022. Healthcare ITnews.

To read the entire article, please click here

Commentary

Telehealth is an important tool for healthcare providers. It allows providers to connect with patients remotely, using technology such as video conferencing and phone calls. This can be beneficial for both parties: providers can save time and money on travel, and patients can avoid having to take time off work or find childcare. In addition, telehealth can be used to provide care to patients in rural areas who might not otherwise have access to healthcare.
There are many advantages of telehealth, which is why this mode of delivery is becoming increasingly popular. First, telehealth can improve access to care by providing services to patients in rural or underserved areas. Second, it can increase convenience and decrease wait times for appointments. Third, it can improve continuity of care by allowing providers to more easily follow up with patients after they leave the office. Fourth, it can reduce costs by reducing the need for travel and office visits.

Case Management and Telehealth

Case management is a process of coordinating care for patients with chronic conditions.  Due to this, telehealth can help case managers.   This can include real-time interactive services such as live video conferencing, as well as asynchronous services such as store-and-forward imaging. Telehealth is often used to support remote patient monitoring, provide consultative services, or deliver continuing medical education.

There is evidence that suggests that case managers using telehealth can be just as effective as traditional in-person case management, if not more so. A study published in the Journal of Case Management found that patients who received care from a case manager via telehealth had better outcomes than those who received in-person case management. The study found that patients in the telehealth group were more likely to receive preventive care services and to have their chronic diseases managed effectively.  Case managers using telehealth can provide their clients with real-time access to medical specialists for consultation, education, and treatment. This delivery model can also be used to facilitate care coordination between providers, which is essential for optimizing patient outcomes.

Telehealth truly helps case managers with better patient outcomes.  There is a growing body of evidence that supports the use of telehealth in a variety of settings and for a variety of purposes. Studies have shown that telehealth can lead to improved patient outcomes, including increased satisfaction with care, improved compliance with treatment plans, and reduced hospital readmission rates. While more research is needed to determine the best ways to leverage telehealth technology to achieve optimal results, the existing evidence suggests that telehealth is a promising tool for improving patient care.

Conclusion

In conclusion, telehealth has the potential to improve case management by providing real-time access to data and patient status, as well as facilitating communication between care team members. With these improvements, telehealth has the potential to improve care coordination and patient outcomes.  It is clear that telehealth has many benefits that can lead to better patient outcomes. These benefits include increased access to care, improved communication between patients and providers, and lower costs. Telehealth can also help to reduce the spread of infectious diseases. As more and more people use telehealth services, it is likely that these benefits will continue to increase.

Please also review AIHCP’s Healthcare Case Management Program and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification in Case Management.  After completing the required courses, qualified professionals can then apply for the four year certification.

With the emergence of telehealth, case management will profoundly change in the 21st Century and many nurses can take advantage of this exciting field by becoming certified through AIHCP.

Additional Resources

“What Is Telehealth?”. NEJM Catalyst. February 21st, 2018. NEJM: Innovations in Care Delivery. Access here

“Using Telehealth to Deliver Nursing Case Management Services to HIV/AIDS Clients”. Jennifer Lillibridge, RN, PhD, etc. al. November 26th, 2008.  The Online Journal of Issues in Nursing. Access here

“Exploring the Benefits of Telehealth Case Management”. Renato Parletta. October 14th, 2022. Insight. Access here

“Telehealth: Mapping the Evidence for Patient Outcomes From Systematic Reviews [Internet]”. Annette Totten, etc, al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Jun. Report No.: 16-EHC034-EF. AHRQ Comparative Effectiveness Technical Briefs.  Access here

Healthcare Case Management Program Article on Risk Management

Posted on by Dominick Flarey

Reducing risk to the patient and improving care is essential for any healthcare organization.  Providing the best care with the best risk management not only helps the patient but also protects the institution from future liabilities and helps the institution provide its mission to provide the best care.  It is because of this that risk management is an essential study and need within any organization.

It is important to manage risk in any healthcare setting. Please also review AIHCP’s Healthcare Case Management Program

 

The article, “Why Healthcare Risk Management Is Important” by Caitlyn Cooley looks closer at the importance of risk management.  She states,

“Medical liability and reducing an organization’s risk against unseen threats has changed exceptionally since the start of the COVID-19 pandemic. We have seen new treatment centers, vaccines, and mass staffing problems across the United States. Risk management strategy “has traditionally focused on the important role of patient safety and the reduction of medical errors that jeopardize an organization’s ability to achieve its mission and protect against financial liability”, according to NEJM Catalyst. Unfortunately, these traditional risk mitigation techniques are not enough to combat cyberattacks on medical infrastructure.”

To read the entire article, please click here

Please also review AIHCP’s Healthcare Case Management Program and see if it matches your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a career in Case Management.

Case Management Program Article on Prolonged Stays in Hospital

Posted on by Dominick Flarey

One of the biggest problems in care is cost.  Long visits and efficient care increase any cost.  Sometimes hospital visits can become so long that cost is driven up immensely.  This may be sometimes necessary but in other cases, better coordination can prevent unneeded lengthy stays that increase cost and insurance issues.

Prolonged stays at hospitals albeit necessary can sometimes become issues cost wise. Please also review AIHCP’s Healthcare Case Management Program

Please also review AIHCP’s Healthcare Case Management Program and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification in Case Management.

 

Healthcare Manager Certification Article on Nursing and Adequate Supply

Posted on by Dominick Flarey

Supply is important for any hospital or healthcare department.  Supplies are critical for nurses to perform their duties and ensure patient health and safety.  With Covid, these supply lines have been challenged.  The importance of inventory is key to good Healthcare Management and keeping a department supplied is critical to success.

Keeping a department in healthcare supplied is key to patient health and nursing success. Please also review AIHCP’s Healthcare Manager Certification

 

The article, “How Hospital Supply Chains Impact Nurses, Patient Safety, and Margins”, from Managed Healthcare Executive Staff looks at some statistics and facts regarding supply needs and how it affects every aspect of care.  The article states,

“Nurses face significant supply chain management problems that impact efficiency, patient safety, and hospital margins, according to a recent survey from Syft, a leading national provider of healthcare inventory control and end-to-end supply chain cost management software and services.”

To read the entire article, please click here

Please also review AIHCP’s Healthcare Manager Certification.  The program is online and independent study and open to qualified professionals.  Also please review AIHCP’s Healthcare Case Management Program which is also online and independent study.  Both programs lead to four year certifications.

Healthcare Case Management Certification Article

Posted on by Dominick Flarey

Healthcare management is a key element in providing quality healthcare.  Unfortunately, the United States and its healthcare system ranks very low in comparison to other industrialized nations.  This has led to the necessity of utilizing healthcare managers to help provide better delivery of healthcare systems by a better understanding of healthcare data and its delivery, population health, competencies of professionals, and care coordination.

Better delivery and outcomes for healthcare are the product of good case management. Please also review AIHCP’s Healthcare Case Management Program

 

The article, “Managed Care-A Plan to the Future” by Patricia Kirkpatrick looks at the critical importance of Managed Care for the future of Healthcare in the United States.  She states,

“Value-based care is here to stay. By developing specific competencies in quality, population health, care coordination, data analytics, governance and care delivery, MCOs can empower their workforces to meet the challenges and opportunities presented by this new model—and ultimately improve health care outcomes for all.”

To read the entire article, please click here

Please also review the American Academy of Case Management’s Healthcare Case Management Certification and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification in Case Management

Healthcare Case Management Article on Readmissions

Posted on by Dominick Flarey

Readmissions is a big issue in Healthcare management.  It is not only important to reduce readmissions for the overall health of the person but also to reduce penalties that limit Medicare funding.  Many hospitals suffer from too high readmission rates and it is critical that hospital management encourage safe and efficient practices to reduce readmissions.  Case Managers can play a big role in reducing unnecessary readmissions.

Good article on readmissions. Please also review AIHCP’s Healthcare Case Management Program and see if it meets your academic and professional goals

 

The article, “Understanding your Readmissions: How to Reduce Penalties” by Marie Stinebuck looks closer at ways to reduce readmissions.  She states,

“Hospitals already suffering from the financial hemorrhage of the COVID-19 pandemic will be hit again by the readmission penalty. More than 2,500, or 83 percent of hospitals in the U.S., will receive reduced Medicare funding for the 2021 fiscal year because of their readmissions from 2016 to 2019.”

To read the entire article, please click here

Please also review AIHCP’s Healthcare Case Management Program and see if it meets your academic and professional goals.  The program is online and independent study and open to healthcare professionals seeking a four year certification in Healthcare Case Management

 

Healthcare Case Management Certification Article on Healthcare Finances

Posted on by Dominick Flarey

Healthcare can be confusing and costly but there are many things individuals do not understand in regards to finances and healthcare. Healthcare affordability is a big issue with the coming election and prices and payment policies are always at the front of voter’s minds.

Good article on healthcare finances. Please also review AIHCP’s Healthcare Case Management Certification

 

The article, “Four Myths About Healthcare Affordability” by Bird Blitch looks at payment options and ideas surrounding healthcare. He states,

“Even when we’re not dealing with a global pandemic and the subsequent economic crisis, paying healthcare bills is often confusing and overwhelming for patients. To make matters worse, there are many misconceptions patients have about healthcare finances, which adds to the confusion. Now is the time to debunk these common myths, some of which may be preventing patients from scheduling the care they need.”

To read the entire article, please click here

Healthcare can be costly but how we finance it can make it easier.  Please also review AIHCP’s multiple programs in healthcare, most notably AIHCP’s Healthcare Case Management Certification and see if you qualify.

 

Healthcare Case Management Certification Article on Care Management Aspects

Posted on by Dominick Flarey

Care Management has a variety of functions, from disease management to utilization management. These management techniques help increase patient outcome and reduce cost.  Case Management is hence a key part of the healthcare system and something many companies and facilities invest thousands of dollars in.  This is especially the case in training healthcare professionals in healthcare management

There are many elements to successful healthcare case management. Please also review AIHCP’s Healthcare Case Management Certification

 

The article, “What We Talk About When We Talk About Care Management” by Leah Marcotte and Joshua Liao looks at healthcare management strategies.  They state,

“Emphasis on care management has become ubiquitous in the era of value-based payment. At the vanguard of the movement, policy makers such as Medicare have emphasized care management via a variety of initiatives, ranging from payment models that encourage longitudinal care management1 to billing codes that reimburse clinicians for coordinating the care of patients who have chronic conditions”

To read the entire article, please click here

Please also review AIHCP’s Healthcare Case Management Program.  The program is designed to help train professionals in the area of case management.  Care and case management are key ingredients to healthcare and AIHCP’s programs continue to be essential in training professionals in Care Management.