Managed Care and Case Management Care
27 August 2012
Managed Care are techniques employed to help reduce the cost for providing health benefits and a system for improving organizations quality of care. The United States National Library of Medicine describes managed care as, “programs that are intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective ...view middle of the document...
The social service professional must be aware that ethical violations occur when social service workers agree to practice utilizing treatment models in which they have not been adequately trained (Apgar 2000, p. 96)
Case management care occurs when the case manager is assigned as representative of a client to plan and monitor services from different social agencies. The agency has primary responsibility to provide service for the client and assigns the case manager who advocates the resources and purchase services for the client. This method would allow the range of services to be expanded because it allows many social workers to coordinate efforts to serve a client as a professional team. The Case Management Society of America defines case management as a process of assessment, care coordinating, planning, and advocacy for services to meet the needs of individual and families to help deliver cost- effective outcomes. The primary goal for case management care is to provide services within treatment settings and to integrate other types of community services for the client. Case management care consists of many key components that include a referral process. In the case management care process the professional becomes an advocate who is assigned the duty of helping the patient with his or her health status. This includes helping the client understand their status, what they can to do about it and what treatments are important to improving his or her health status (Alexander, Lemak, & Pollack, 2007).
Alexander, J., Lemak, C., Pollack, H., Case Management and Client Access to Health and Social Services, Journal of Behavioral Health Services and Research, July 2007 Vol. 34 Issue 3 pp.221-236
Apgar, D., Providing Mental Health Services at What Price? Ethical Issues and Dilemmas for Social Workers Practicing in Managed Care Environment, Critical Strategies: Psychotherapy in Managed Care, (2000) Vol. 1 Issue 1, p. 87
http://www.cmsa.org. Case Management Society of America; retrieved 27 August 2012