Conventional Case Management Case Study

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Conventional case management (CM) commonly referred to as traditional case management or large case management is defined as the identification and management of inpatient cases which are of high costs. Once a case relevant to CM program is identified, an analysis is done that recognizes the goals, problems, and solutions. CM includes the management of the case by a single department or nurse that covers various services like home care, rehab, out-patient care, ancillary services, and hence forth. CM is a combination of qualitative and cost-effective care. A common point of break down in CM facilitates the shift of information to the patient’s physician from the inpatient physician. The approaches of CM involve community resources (catastrophic…show more content…
DM bolsters the physician-patient relationship, stresses on the prevention of complications by using the evidence based practice and other strategies that empower patients. DM also analyzes the clinical and economic behavior of patients in order to improve the overall health of the individuals. The components of DM include the process of identifying the population, practice of evidence based guidelines, education to patients on self-management, routine reporting, and collaborative practice models. For patients with chronic illnesses, home and remote monitoring technology serve as DM components for improving the quality and cost of care. Most of the DM companies use algorithms as a diagnosis-finding strategy to the payer’s claims data. Beyond the dependency of the diagnosis code, various predictive tools are used to plan for the intensity of outreach resources (Kongstvedt,…show more content…
For most of the conditions in CM intervention is 60-90 days and for DM is 365 days. In case of CM, the site of interaction is mainly a hospital, hospice, and or an acute facility which is driven by support services, transportation, and community resources. On the other hand DM is driven by medical regimens which are non-adherent in the site of interaction includes school, home, office, and work. The outcome metrics for CM are based on single admit, length of the stay, and the cost per case where as for DM it is the annual cost per diseased member along with the gaps in care (Kongstvedt,

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