Utilization & Case Management

Utilization & Case Management

Introduction

            Case management involves a small team or an individual in the healthcare environment that is responsible for clearly steering the patient through a composite procedure in the most effective way that is accepted (Uittenbroek, et al., 2018, p. 2). For the outpatient setting and or acute setting, case management can take place. A small team and an individual in the case management are responsible for care coordination, care planning, patient assessment, patient’s advocacy, and or evaluation. The main focus of utilization and case management is to help the patient achieve the maximum level of functional capabilities and wellness. The Advanced Practice Nurses have the responsibility of understanding the case management and utilization process.

How is this related to managed care and quality care and control issues?

Managed care helps in quality healthcare management and controlling the costs of healthcare services. Therefore, managed care has to main objectives of quality healthcare services and fees control. Utilization has a relation to the managed care in that. Utilization evaluates the quality of services in healthcare and the costs. The second goal of managed care is quality care attainment, which is the overall objective of case management. Therefore, case management and managed care are related. The control issues in the healthcare environment focus on effective healthcare management, for example, healthcare services, healthcare resources, staff in the healthcare environment, and the systems relating to social service. Therefore, the utilization and case management refers to the control issues.

How do APNP clinical expertise and patient management skills provide a foundation for

Utilization and case management?

The Advanced Practice Nurse Prescriber (APNP) designates the unique population of the patients. For example, the health issues regarding women, adult gerontological, and pediatric (American Association of Nurse Practitioners, 2020). The APNP has unique attributes of complex skills of decision making. They also have clinical competence and expert knowledge which form a great foundation for case management and utilization.

Provide an example of how case management improves patient care outcomes.

The most compelling case management that is associated with the patient-centred Medical Home greatly contributes to improved patient outcomes. It is focused on the optimal productivity of the care provider and cost-effectiveness. Based on the research studies in North Carolina, community healthcare with the patient-centred Medical Home led to the cost reduction of approximately 17% for every member per month (patient-centred Medical Home Lessons Learned in North Carolina)

Reference

Patient Centered Medical Home Lessons Learned in North … (n.d.). Retrieved from

http://ncnc.unc.edu/files/2014/06/PatientCenteredMedicalHomeLessonsLearnedInNC.pdf

AANP: The American Association of Nurse Practitioners. (n.d.). Retrieved from

https://www.aanp.org/

Uittenbroek, R. J., Asselt, A. D. I. V., Spoorenberg, S. L. W., Kremer, H. P. H., Wynia, K., &

Reijneveld, S. A. (2018). Integrated and Person-Centered Care for Community-Living Older Adults: A Cost-Effectiveness Study. Health Services Research, 53(5), 3471–3494. doi: 10.1111/1475-6773.12853