The modern generation has seen a number of changes in various fields and institutions. This is attributed to the fact that man has to keep changing with the moving trends across the globe. One of the systems that have seen drastic changes in how they are managed globally is the healthcare system. The introduction and embrace of case management programs in healthcare institutions has been of great significance(Daniels & Frater, 2011). What are case management programs? Case management programs are not familiar to many but have various definitions depending on the type of health organization. Such programs mainly target people with illnesses such as HIV/AIDS, which is one of the deadly diseases worldwide. Other diseases and complications targeted by such programs include paraplegics and spinal cord injury. These are illnesses that require both social and medical services. Case management programs are always concerned with improving the quality of health care rather than just reducing the cost of the same. This is because in most cases the programs focus majorly on patients with long term needs of care. Due to the quality service offered by the program, it is seen to have undergone evolution in various healthcare organizations. In health care institutions, case management programs play integral roles such as ensuring provision of quality healthcare. Besides, the program involves primary healthcare consultation services which are vital for healthcare organizations. Other areas in healthcare organizations boosted by the program include situations where patients require special care and attention such as high risk pregnancies, transplant facilities and disease state management. All these activities aim at the provision of better health care with less emphasis on the cost involved. It is evident that the program has become a very important element in providing quality health care(Gold et al, 2012).
Although this program has a number of commendable values, it has some limitations. This is seen in the manner in which it falls short in providing very comprehensive and effective treatment to the affected individuals. This program tends to focus exclusively on the environmental interventions while ignoring the psychological perspective of individuals’ functioning. In most cases, the program does not provide patients with therapy techniques which are evidence based, such as those developed from cognitive behavioral perspectives. Conversely, during the program, clients with mental illnesses are not adequately provided with skills that can help them to systematically lower their emotional and psychological disturbance. Besides, the package that is offered by this program can only provide a limited level of support. As a result, clients often need to supplement with care from friends, neighbors and family members. Despite the various challenges, the program has its strengths. To begin with, it is evident that the program works closely with clients and their families to develop plans that aim at achieving goals of particular health organizations. Notably, the kind of support provided by the program focuses on meeting the needs of a client. Apart from the physical and medical support offered by the program, it is worth noting that the program also provides assistance and funding that help in organizing a wide range of services in health care institutions such as support, nursing and personal services (Moreo et al, 2013).
Taking into consideration the program’s evolution of the years, it is evident that it willbecome a medical necessity in future. Some medical conditions are long term hence they require long term attention. Attention of such kind to patients can only be provided by the case management program. In some cases in health organizations, patients undergo hard time due to neglect by family members after hospitalization. In fact, other victims of neglect have ended up not improving health wise due to poor health care services they get from the irresponsible family members. Over the decades, case management program has been working tirelessly in ensuring that such clients get the most appropriate and effective healthcare services(Sanders, 2012). However, the program has never been integrated and implemented as part of the medical program. This has ever since called for its incorporation in the medical program in healthcare organizations. People suffering from long term illnesses such as HIV and other complications such as spinal cord injury and paraplegics require long term care and treatment. This can only be provided by the case management program as it has done before in similar cases. Most health care providers do not follow up their clients after treatment; neither do they provide healthcare services to find out their well-being after treatment. Since the program has been seen to play an integral role in such situations, it is worth noting that there is a growing need of it becoming a necessity not only in the future but also in the present. Additionally, in the modern world, it is evident that there is a rapid expansion of human services that has led to fragmentation and poor coordination of the health care services. This has resulted to a need for incorporation and implementation of the case management programin medical institutions today and in future.
The case managers in the case management programs are at times thought of as “gatekeepers”. The “gatekeepers” play an integral role in the entire process.For instance, during the program, they are able to consult with healthcare providers in order to determine the nature of care required by a patient. In most cases, when this kind of coordination is unavailable, it may be difficult for care providers to effectively deliver their services. Moreover, the gatekeepers play a pivotal role in ensuring that clients receive the desired and affordable healthcare services(Anonymous, 2010). Additionally, they also control how health care institutions utilize resources and this goes hand in hand withcoordination of hospital admission, surgical consultation, diagnostic testing, specialist consultation and social services. All these services are important especially in the process of discharging and delivery of better health care services. The social aspect of this process is very important since it plays a very integral role in creating a strong link between the client and the healthcare provider. This would always enhance the efficiency in provision of services to clients. The roles of gate keepers especially in areas such as hospitalization, inpatient surgery, rehabilitation, long term care, home healthcare, outpatient surgery and surgical evaluation are important especially in the case management program (Anonymous, 2010). All these roles put together, are very important in any healthcare organization. Therefore, it is evident that without “gatekeepers”, the case management program cannot achieve its goals and objectives. Certainly, “gatekeepers” should always be involved in the development and growth of health care institutions.
Anonymous (2010, June 8). Care coordination in medical homes, accountable care systems forecasts pivotal role for case managers. PR Newswire. Retrieved August 2012 from Proquest Case Management Focus Group Report, National Institute of Allergy and Infectious Diseases, National Institutes of Health.(n.d.).
Daniels, S., & Frater, J. (2011).Hospital case management and progression of care. Healthcare Financial Management.65(8) 108-13.
Gold, M. R., Jacobson, G. A., & Garfield, R. L. (2012). There is little experience and limited data to support policy making on integrated care for dual eligibles. Health Affairs, 31(6), 1176-1185.
Moreo, K., Moreo, N., Urbano, F. L., Weeks, M., & Greene, L. (2013). Are We Prepared for Affordable Care Act Provisions of Care Coordination? Case Managers’ Self-Assessments and Views on Physicians’ Roles.Professional Case Management. 19(1) p 18-26
Sanders, B. (2012). Managed care under the microscope. New Hampshire Business Review, 34(9), p. 1.