What Is the Real Objective of Case Management Quality of Care vs. Reduced Costs - Essay Example

Download file to see previous pages However, it is questionable whether these systems can offer both quality and low costs. By coordinating the healthcare needs of a patient requiring multiple services from multiple providers, studies of disease management programs have shown that these programs do improve quality by offering interventions such as pre-recorded telephone reminders or home visits by medical professionals (Rand Corporation Study).

According to the Rand study, conditions such as diabetes and congestive heart failure (CHF) benefited from case management and reduced costs by decreasing hospital admissions, while patients suffering from depression were more apt to use outpatient services and prescription drugs, increasing costs. Six chronic conditions were analyzed in the study: CHF, coronary artery disease (CAD), diabetes, asthma, depression, and chronic obstructive pulmonary disease (COPD). Improved quality was found in four of the six illnesses, with inconclusive results for asthma and COPD. Long-term health outcomes have not been determined, however, because the study covered only one year.

In a one-year study by Michael Long, professor at Wichita State University, geriatric patients who were at least 75 and functionally impaired were randomly assigned to a regular-care group or a case-managed group. The goal was to eliminate the fragmented care that often exists for these patients. Both benefits and costs must be taken into consideration before determining success or failure in such a patient advocacy program (Long). The goal should be set by a team and success determined by whether the goal is met. In Long's study, the case-managed group benefited more than the regular-care group, and improved quality was the result. Cost and quality are sometimes considered opposing factors, but Long considers this too simple an explanation. He recommends a formula: Quality=Benefits - (Risk and Cost), which takes into consideration all the factors involved in case management programs.
Limitations of Case Management Programs
In a more expanded study, consisting of 46 states examining HMOs and primary care case management (PCCM) programs, the reporting states tended to emphasize utilization results over quality-measure results. In states where many commercial health plans have recently abandoned Medicaid contracts and some rural areas of the United States have been unable to attract health plans, PCCM programs are distinct from capitated managed care plans in that the Medicaid agency purchases health care services as if it were a health plan (Schneider et al). A comparison of quality oversight PCCM programs and health plans serving Medicaid beneficiaries indicates that states with both have fewer expectations for PCCM programs and do not seem to have a distinct goal. At present, the study found that PCCM programs have not as a rule collected performance data, thereby lacking the means to improve quality care.
Strengths of Case Management Programs
One area in which healthcare costs are accelerated is with the high number of diabetics needing treatment, and case management is highly recommended for glycemic control in these patients. As noted by The Guide to Community Preventive Services online, "Diabetes management is complex and difficult for both patient and healthcare provider, and traditional healthcare delivery methods have not adequately met their needs" (Case Management Interventions). The Guide goes on to say that a systematic review shows case management delivered as part of disease management to be effective in adults with Type 2 diabetes.
Managed care strategies for Medicaid populations in Florida, North Carolina, and ...Download file to see next pagesRead More