Case Management in Managed Care Case workers role has been Influenced by managed care and new cost containment strategies which are creating competition and role conflict. Mental health care services theme has become an organized philosophy undergoing massive change. United States managed care leads In healthcare decisions, applying cost effectiveness, evaluation in reimbursement, pharmaceuticals, drug treatments, health maintenance organizations (HOMO), pharmacy benefit management firms (BOMBS) and operating hospitals.
In this paper I will explore the evolving role of cost-effectiveness in manage care. Since the ass’s, case management has been a factor in the United States healthcare system. Just as healthcare continues to evolve so has the function of care management. Care systems have several components; It has been described as a patient delivery system, a professional practice model or coordinating care. One thing that Is certain Is the fact that there Is no clear definition of case management because of Its elusiveness. Case Management) Schools (1995) defined managed care s “any kind of health care services which are paid for, all or In part, by a third party, including any government entity. (Grosbeaks 1998) The importance of clinical case managers have increased within the mental health field. Clinical case manager are typically licensed clinical social workers and psychologist responsible for making sure treatments are manageable. Coordinating various entities for patients as well as being the professional point of contact. Clinical case managers also oversee patient’s benefits; these are just a few of the required duties provided.
The clinical case workers are the medium between the providing facility and managed care company while also working with patients to ensure the benefits provided by the patients Insurance Is used appropriately. Case management and community treatment play an Important role In managing mental health care services according to the article, _Managed Care and Evolving Role of the Clinical Social Worker in Mental Health. _ (Cohen 2003). Managed care companies have continues to narrow the scope of clinical social workers and psychologist by expanding medicinal provider’s role and susceptibilities.
Although clinical managers provide an array of services to mental health care patients; managed health care sees social workers as a source of economical substitutable labor to clinical psychologist and psychiatrists in reference to patient’s treatment. 65 percent of the treatments administered are through clinical social workers, which lead to managed care companies relying more on social workers to keep medical cost down. Due to the consistent changes In health care, companies are not allowing consumers to choose their health providers, a panel of revisers are made available to them which may have a decreasing affect for some practitioners.
More often medicinal practitioners are replacing more psychiatrists and dominating the medical mental health field. It is expected the next stages of development will include managed care used on a system wide integrative basis. Many challenges are still presented however clinical social workers developing more frequently in the mental health field. To continue providing cost effective health care, clinical social workers as well as the institutions here the training and education is completed must be prepared so advantages and opportunities continue to be made available.