Case management: beyond the walls.

Abstract

Managed care and capitation will become increasingly familiar in the Central Valley of California as managed care arrangements capture more of the marketshare. This type of healthcare environment presents a myriad of opportunities for case management to affect quality and cost outcomes within healthcare organizations. Assessment skills (clinical outcomes), client-provider relationship (member satisfaction), and resource coordination (cost containment) are three key elements underlying the role of the case manager, making the role components congruent with the needs of a managed care population. As payers continue to mandate outcomes measurement, case management beyond the walls or outside the inpatient setting is a technique that will increasingly be used to document that the diverse needs of high-risk patients are met.