It involves an integrated system that manages the delivery of comprehensive healthcare services for enrolled patients.
The American Case Management Association (ACMA), a non-profit association dedicated to the support and development of the profession of case management through educational forums, networking opportunities, legislative advocacy and establishing the industry's Standards of Practice,[2] defines case management as:[3]a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality cost effective outcomes.Case management focuses on delivering personalized services to patients to improve their care, and involves four steps:
The amount of involvement an insurer can have in managing high cost cases depends on the structure of the benefit plan.
These, for instance, include local influences such as the response to cost by funders of care and consumer pressure.
The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination.
The ACM Certification requires professionals to apply, demonstrate two years of hospital case management experience and licensure as a nurse or social worker, and to sit for and pass an examination.
ACMA is the association solely for Hospital Case Management professionals, and currently consists of more than 4,500 members, and is represented by 21 state chapters nationwide.
ACMA provides hospital-focused education and networking for Case Managers – including nurses, social workers, physicians, administrators and other health care professionals.