Case Management Insider

Redefining Case Management
What is my cover limit? What Dental facility is closest to my office that I can visit? We have an emergency case requiring airlifting to Nairobi for specialized care, how soon can we expect the air ambulance on ground? We are awaiting instructions of discharge to enable us release the member and with that also comes the hospital’s dreaded phone call; ‘ you have not reconciled our hospital account and we are expecting a payment of XXX amount in the next three days’ failure to which we shall suspend your account!

This is typically half an hour’s scenario of a case manager’s day in the healthcare business. Case Managers are key stakeholders with a pivotal role in nature as they are the ‘glue’ between the patient, family and service provider. They facilitate the interdisciplinary approach within the care continuum; as the ‘Special force’ and ‘gate keepers’ ensuring quality and cost effective healthcare. This is a role of passion and of continued governance sculpture to redefining case management function and its speak to the bottom-line performance.

What is case management?
Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effectiveness.

Modern Approach to Case Management
A new specialized approach is imperative to good patient outcome and better performance of the medical insurance book. Other medical disciplines need be integrated in the case management function such as Lab technologists, physiotherapists, occupational therapists, psychologists, Wellness Coaches and nutritionists for a more integrated approach and navigation of the complex health eco-system.

The case management function is not only in health insurance companies but has also been taken up by other stakeholders like hospitals and large corporate. This is in realization that case management makes a unique contribution towards the integration of health care, social services and other sector services.