Care vs. Case Management: 7 Structural Differences

Thursday, December 12th, 2013
This post was written by Cheryl Miller

While there’s no law defining the differences between care and case managers, there are seven structural differences, says Jullie Gray, MSW, LICSW, CMC, principal of Aging Wisdom, and president of the National Association of Professional Geriatric Care Managers, NAPGCM.

Despite the differences, geriatric care and case managers ultimately face the same issues: an aging population, a dwindling supply of geriatricians, and caregivers that need help caring for their ailing family members, while at the same time honoring their “autonomy and safety,” Gray says.

Following is her assessment, based on reviews of NAPGCM’s standards of practice compared to the Case Management Society of American’s (CMSA)’s standards of practice, and various national and regional group member meetings.

To find a care manager, go to National Association of Professional Geriatric Care Managers To read an interview with Gray, click here.

Care Management

Case Management

Background of professional

Diverse – Social work, nursing, psychology, gerontology, other health related fields

Social workers and nurses primarily (with some mental health counselors)

Employed

Primarily private for profit (some nonprofits)

Agency/organization: insurance company, hospital, community mental health, etc.

Government: Medicaid program, housing authority, adult/children’s protective services, veterans’ programs, etc.

Limits

Client defines the scope of work (based on a care plan that is developed with the client’s input)

Agency defines the limits/scope of work. Typically will be managing a specific disease, issue, condition or event, and focus may be constrained by regulations, policies and funders

Focus

Holistic, client/family centered approach

Understanding underlying client/family dynamics

Advocating for client needs & the client’s maximum benefits (i.e., from an insurer)

Client/patient centered but also considers medical/legal/financial issues that can involve stakeholders

Eliminating  non-compliance and over-utilization

Stakeholder

Client

Can be a funding source (i.e., insurance company, entitlement, hospital, etc.)

Payment

Client pays cost (occasionally some reimbursement from long-term care insurance but this is not typical)

Agency specific funding (hospital system, insurance company, government program, for example)

Goal

Promote better quality of life, maintain independence to the extent possible, improve communication among those involved in client’s care, ensure client’s needs are met and client’s goals are achieved, provide education to client and family members

Improve health status, cost effective outcomes and efficiencies, reduce overutilization of services

New, FREE Case Management Trends Download

For additional data on care and case management trends, download the FREE executive summary: More Care Team Integration; Face-to-Face CM Encounters Edge Out Telephonic

With each year, a larger swath of the healthcare industry comes to rely upon the skills of healthcare case managers to influence clinical, quality and financial outcomes. According to the 2017 Case Management Survey by the Healthcare Intelligence Network, the percentage of healthcare organizations enlisting case managers in care management rose from 88 percent in 2013 to 94 percent in 2017. Further, patients are much more likely to encounter a case manager in a provider’s office this year than they might have been four years ago. Two-thirds of 2017 respondents embed or colocate case managers alongside care teams today, versus 54 percent in 2013.

Download this HINtelligence report today for more data on the top clinical targets of healthcare case managers; the top means of identifying and stratifying individuals for case management; and the most common locations of embedded or colocated case managers.

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