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Why Care Management is so Important
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Why Care Management is so Important

Nov 13, 2017 by Sharon Gauthier RN/MSN/CGM 2 min read

Managed care escalated in the 1990s when costs rose for insurance companies who wanted to get a handle on the utilization of benefits. Nursing entered the picture more at that time to assist with utilizing funds allocated toward care. Thus the role of a nurse engaged in Case Management became more popular, leaving social workers still involved but not involved with the medical management of those patients while inpatient.

Fast forward to the twenty-first century, and physicians and hospitals are mandated to coordinate care across all regions for patients when they are discharged. What does that mean to practices that now have been bought by hospitals? It's challenging for physicians who did little with the care management of patients in the past. And now that buyout from the hospitals costs them their practice. Meaning they no longer have what is a luxury of spending time with their patients. Seeing 28-30 patients a day or more means a quick turnaround and perhaps depending on nonlicensed personnel to extrapolate information that may keep patients from going to the hospital instead of their doctor.

Medicare is now telling hospitals and practices that they HAVE to manage these patients better, or they will be penalized. Accountable Care Organizations have been developed to assist with this mandate. Imagine developing an organization to make the healthcare system accountable for care.

Where will this go?? No one knows for sure. Lots of products developed forms and processes to make sure patients don't return. Lots of money was spent, again with consultants and large companies wanting to cash in on an opportunity.
What do we need? Someone to be in charge. It's that simple. In charge of ensuring those in need are assisted with navigating and evaluating their needs before they become a crisis. Accountability, imagine a healthcare system accountable across all lines of care.

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