Part One: Basics of Case Management, Five-Part Series-Basics of Case Management Part 1 Presentation

Basics of Case Management Part 1 Presentation

Pdf Summary

The 2024 Case Management Boot Camp session by Georgia Hospital Association focuses on foundational practices and evolving trends in case management relevant to healthcare's challenges and reimbursement models. It highlights the current U.S. healthcare landscape, characterized by high spending with suboptimal outcomes compared to other developed nations. The U.S. healthcare system spends a significant portion of its GDP on healthcare, yet lags in life expectancy and infant mortality rates. <br /><br />Case management plays a pivotal role in addressing these inefficiencies by coordinating care to improve patient outcomes and manage costs effectively. Different organizations, such as the Case Management Society of America and the American Case Management Association, define case management as a collaborative, comprehensive process encompassing assessment, planning, advocacy, and facilitating resources to fulfill patient needs.<br /><br />The module also delves into federal reimbursement systems, describing Medicare and Medicaid structures. Medicare categorizes patient cases using Diagnosis-Related Groups (DRGs) to determine hospital payments, incentivizing efficient care delivery. DRGs consider factors like complications, comorbidities, and length of stay. The shift towards value-based reimbursement models requires hospitals to focus on outcome-oriented care, with emerging models like bundled payments and Accountable Care Organizations (ACOs) promoting coordinated, quality-driven healthcare systems.<br /><br />Additionally, case management's evolution and adaptation to community settings are crucial for managing high-risk patient populations and integrating services across the continuum of care, aiming to reduce unnecessary hospital visits and improve overall patient satisfaction.<br /><br />Overall, the module underscores the significance of case management in optimizing healthcare delivery in light of evolving payment models and the need for efficient care coordination to address the challenges faced by the healthcare industry today.

Keywords

Case Management

Healthcare Challenges

Reimbursement Models

U.S. Healthcare

Patient Outcomes

Medicare

Diagnosis-Related Groups

Value-Based Care

Bundled Payments

Accountable Care Organizations