Financial Case Management - Essay Example

It needs active engagement and passion of senior leaders because the separation between business goals and clinical goals must be eliminated. The physician who functions as a medical director, a nurse who functions as a full-time clinical officer or case manager, and a hospital administrator should set clinical improvement goals together and discuss how to best manage quality health care. Accountability must be established and designed to review clinical and financial outcomes. However, providing sound clinical and financial information in a timely manner is essential to the process.

Electronic medical records revolutionize health care due to the availability of evidence-based protocols and pharmaceutical applications that gives easy access to practitioners to the best research on a specific disease condition. Most hospitals have a computerized electronic hospital information system that helps administrators collect and analyze financial data and electronic medical records for clinical data. But the two systems are not linked. Combining the data from both systems is seen as a necessary ingredient in effective clinical and financial case management A combined system can also schedule appropriate resources needed to provide services.

These electronic systems help case managers streamline the process of verifying the level of care the patient requires and the willingness of his insurance carrier to reimburse the hospital for that care (Yoder-Wise, 1999). Scientific studies continue to document that poor care is being delivered despite a significant amount of money spent in providing care service. Ineffective and inconsistent care leads to bad outcomes and higher costs due to the absence of an organized approach to management (Harrison, Nolan, & Sucro, 2004).