Medical Case Management Explained

Medical case management is a process that facilitates treatment and rehabilitation plans for people with identified needs (disabled, injured or ill). It is a collaborative process and involves care assessment, assisting with the implementation and coordination of subsequent care plans, regular monitoring of progress and evaluating and reviewing results. The aim is to improve their quality of life and to give patients as much independence as possible. Independent living and quality of life are the goals.

The need for case management arose in the first place because people weren’t getting all of their requirements met from single agencies. Case management filled these gaps in services and created a way for patients to have all of their needs addressed.

Every patient will be unique and so each situation and treatment plan will also be unique. Some people will need case management services for life, whereas other will need it only for the medium term. Often, the client has had a dramatic change in circumstances which they need help dealing with, such as a spinal injury. Sometimes they will have health issues from birth such as cerebral palsy. An individual will be tasked with the overall case management of a client and this person will be allocated based on their experience and compatibility.

Case managers come from professional backgrounds such as occupational therapy, nursing, social work and physiotherapy.

The initial part of their job is assessment. Relevant information needs to be gathered from the client, family members and medical practitioners. The point of the assessment is to develop an appreciation of the individual's health issues and to plan how to reduce the impact of their situation on their level of independence, personal safety, family life, finances, social life and employment prospects.

The job of case management can involve many facets including advocacy, helping families with securing funding, assisting them with talking to external bodies, attending meetings with them and making families aware of all potentially useful support groups. The job also involves ensuring everyone understands the legal and medical jargon used.

Rehabilitation goals will be identified by the case manager and the most appropriate and cost effective care plan will be implemented. The case manager will make and update written records of progress and reviews of care will take place at specified intervals agreed by the client or those acting for them.

Case managers follow the BABICM code of ethics to guide them through their work. This ensures the best ethical care is given at all times. They will need to develop a good relationship with the client and family and they will become an extremely important part of that person’s life as they aim to improve it.