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The Employee Retirement Income Security Act and Health Maintenance Organization Litigation
Published in Julie Dickinson, Anne Meyer, Karen J. Huff, Deborah A. Wipf, Elizabeth K. Zorn, Kathy G. Ferrell, Lisa Mancuso, Marjorie Berg Pugatch, Joanne Walker, Karen Wilkinson, Legal Nurse Consulting Principles and Practices, 2019
Case management is a type of utilization management, overseen by a “case manager” usually a nurse or social worker employed by the HMO (or other insurance provider). Case management differs from utilization management in that “utilization management examines how services are being utilized, whether or not the services are effective and how much money it costs to provide the services,” while case management “coordinates care and assists the patient to navigate social service systems to attain the highest quality of care.”23
Age and aging
Published in Laeth Sari Nasir, Arwa K Abdul-Haq, Caring for Arab Patients, 2018
Education on the role of case management, which is designed to contain healthcare costs and improve the quality of care delivered, should be emphasized. Also, increasing emphasis should be placed on community-based geriatric services, on preparing geriatric social workers for work with families and communities to facilitate linkage with the formal health system, and on advocacy as well as other roles.
Brain injury, mental health–substance use
Published in David B Cooper, Introduction to Mental Health–Substance Use, 2017
There is some evidence that case management improves outcomes. If intra- and interdisciplinary professionals and family are involved, coordination of these activities needs to occur. Case management involves the following functions: ➤ assessment➤ planning➤ linking➤ monitoring➤ advocacy➤ individual identification and outreach.27
Twelve tips to center social accountability in undergraduate medical education
Published in Medical Teacher, 2022
The curriculum of many medical schools is structured in a manner that front-loads the learning of social accountability into pre-clinical training. There is often less institutional support for students to translate social accountability and advocacy from theory into practical applications throughout clinical training, but there needs to be added weight in the curriculum to keep circling back to these concepts. Students must be able to observe, practice, and contextualize their pre-clinical learning of these concepts to fully appreciate how social factors relate to patients’ clinical presentations, and how social changes, advocacy, and medical management are interwoven together. Clinical applications can be found in involving multidisciplinary teams in case management discussions to foster holistic care and improved patient outcomes (Fewster-Thuente and Velsor-Friedrich 2008). Other experiential activities to emphasize concepts of social accountability throughout clinical training can include engaging with CSL programs, case seminars (Hofsten et al. 2010), intention/reflection practices (Fierke et al. 2019), and clinical post-conference (Hannans 2019).
Client characteristics associated with desire for additional services at syringe exchange programs
Published in Journal of Substance Use, 2022
Daschel J. Franz, Camille C. Cioffi
Multidisciplinary case management has been shown to facilitate the implementation of medical and social support services and help clients navigate and access such services (Wolfe et al., 2010). In addition, integrating case management services that provide direct services and utilize referral networks informed by SEP client needs at SEPs can help address the multitude of structural inequalities WWID face while also addressing safe injecting practice, HIV prevention, and SEP clients’ specific needs. Given our findings, we encourage policymakers, clinical professionals, and case managers to consider polysubstance use and pregnancy history to inform the variety of services offered at SEPs or referrals to community organizations to ensure that needed services are tailored and accessible to SEP clients.
A comparison of routine and case-managed pathways for recovery from musculoskeletal disorders in people in employment
Published in Disability and Rehabilitation, 2022
Beverly P. Bergman, Evangelia Demou, James Lewsey, Ewan Macdonald
The traditional model of management of musculoskeletal conditions in the UK follows a pathway of initial presentation to a general practitioner or accident and emergency department, with onward referral to a physiotherapist or appropriate specialist as necessary. For non-urgent conditions, waiting list delays can be substantial, potentially leading to prolonged absence from work and perhaps worsening of the condition. In 2011, as part of the redesign of Scotland’s Allied Health Professional (AHP) Musculoskeletal Services (MSK), NHS Scotland introduced a pilot MSK National Advice and Triage Service (MATS) aimed at improving the management of non-emergency musculoskeletal disorders [12]. The service operated at three levels; self-management, accelerated access to AHP care via a central “MSK hub”, and referral to an existing case-managed service, Working Health Services Scotland (WHSS) aimed at self-employed people or those working within enterprises employing less than 250 people [13,14]. Case management involved referral of the patient to a trained case manager, who acts as a coordinator for the care pathway, facilitating access to services and monitoring progress. The case management approach of WHSS followed the holistic biopsychosocial model [11,15] as distinct from the more traditional medical triage model of MATS. WHSS aimed to assess and offer treatment within 5–10 days of referral, as opposed to the routine NHS waiting times of the MSK service.