Building systems to measure continuity of care.

Abstract

Case management is the primary means to provide continuity of care across multiple institutions and practitioners. Traditional case management is becoming more complex, because in a managed care environment, financial decisions may be as important as clinical decisions. Decisions on extended treatment may have to be justified to the patient's insurance company and may have to be based on pre-approved treatment criteria. If not properly authorized, treatment costs could be denied, leaving the patient with sizable medical bills and increased dissatisfaction. A good computerized case management system can capture data from disparate sources, integrate it into common databases, display it in a real-time fashion to case managers, report it using standard (or custom) reports or templates, and have the capability to trend and project future treatment. This article offers case managers practical advice on the options available for obtaining or customizing a case management system that will be appropriate for their needs in a managed care environment.