Case Management in Health Care


Case management focuses primarily on facilitating care delivery for vulnerable clients including the elderly and people with chronic illnesses. The condition of these patients, coupled by the fragmentation in the healthcare system, makes case management a necessary healthcare service. Compared to the traditional care, the current case management offers an integrated service in multiple settings. Ideally, if the healthcare delivery system had the capacity to offer patient support and enhanced communication, there would be no need for case management. However, the fragmentation of the care delivery system makes case management an essential service in satisfying client needs. Case management has overall benefits to patients through a cost-effective care at many settings. The family benefits through access to essential care information and the provider through conserving time. Case management programs provide aim at providing quality managed care tailored to meet patient needs.

Programs of Case Management

Case management programs enhance collaboration in the planning, monitoring and evaluation of care services in order to meet the patient health needs. In my opinion, case management, through the enhanced communication involving a variety of settings, aims at promoting the quality of care than reducing the cost of care. Essentially, all care management programs involve outreach, assessment, care planning, frequent screening and intake.

Burns and Perkins identify four variables that influence the kind of case management in any care setting: the gate keeping mechanisms, organizational factors, funding and the target patient of the program (2000, p. 4). Most care management programs are client-centered offering service to patients at multiple settings whether at home, nursing home or any health facility. According to Bower, case managers strive to facilitate a high quality service to a patient consistent with vulnerability and individual preferences (1998, p. 8). In this way, quality care, tailored to suit patient needs, is possible under case management programs, as opposed to centralized hospital care.

In my view, the framework of care management puts more weight on ensuring quality care than on reducing costs. Case management involves five core functions that promote quality care; firstly, the standardized, regular and comprehensive assessments and reassessments ensure that the care meets the client’s health needs. Secondly, case management programs identify the specific client and system wide goals. Thirdly, the case managers coordinate resources and information and involve practitioners from diverse health specialties to ensure high-quality care. Without this, referrals and care information would not be available to patients or family. Most importantly, case management undertakes regular monitoring of patient health status. This ensures that service delivery is appropriate to achieve the desired health outcomes.

Strengths and Challenges of Case Management

Case management program is a widely accepted approach for vulnerable patients’ e.g. case management for the elderly frail. Compared to other approaches, case management is cost-effective and ensures quality care, and thus of enormous benefits to the patient, the care providers and the family. In particular, it enhances communication, continuity and patient support in an increasingly fragmented health system.

The patient benefits through improved care in convenient settings at a cost-effective way, participation in healthcare decisions and access to essential information on available care options for him/her. The family, on the other hand, gain expertise, emotional support and guidance from care managers that help them make informed care decisions regarding the patient. Additionally, the provider benefits by accessing care from other providers, monitoring and evaluation of care to explore other care options and saving time.

The challenges that face case management generally concern patient dissatisfaction with the programs particularly the elderly frail. In particular, the link between care managers and the physicians is often a weak one. According to Taras et al., care managers, though pivotal in coordinating health resources, do not have authority over physicians (2004, p. 6). This tends to affect the delivery of service to meet the elderly patient needs. Additionally, effective engagement of the patients or their family is often difficult due to the complex nature of the care delivery system. This means that the care managers cannot be administer the services in a consistent manner, which affects the outcomes.

Case Management in the Future

Given the many benefits of case management particularly on vulnerable clients such as the frail elderly, it will, in my view, a necessary medical program in the future. In my opinion, integrated case management ensures that patients receive appropriate services in the current fragmentation of the health system. Besides, the current emphasis on ensuring universal care regardless of the settings indicates the increasing recognition and value given to case management. In my view, case management, compared to traditional care approaches, offers a flexible array of care services that increase patient outcomes. Its use of interdisciplinary tools and resources helps in the management of care across many settings.

In my opinion, in case management, the care managers or “gate keepers” provide essential linkages between the client and the physician. Their role entail managing patient care, allocation of health resources based on the patient needs. In this way, they ensure that the case provided reflects patient needs hence essential in case management.


Case management essentially aims at providing service that meets patient needs in a cost-effective way in the wake of fragmentation of the care system. In my opinion, case management primarily improves the quality of care, as opposed to reducing the overall costs. Case management has many benefits for the patient, the care provider and the family. However, challenges such as the role of care managers in coordinating the physicians affect service delivery.

Reference List

Bower. K. (1998) Case management: Unraveling the confusion. Orthopaedic Nursing, 17(5), 7-11.

Burns, T., & Perkins, R. (2000). The future of case management. International Review of Psychiatry, 12, 3-5.

Taras, H., Wright, S., Brennan, J., Campana, J., & Lofgren, R. (2004). Impact of School Nurse Case Management on Students with Asthma. The Journal of School Health, 74, 6-9.

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