Question

1. Describe a scenario in which managed care provides an effective solution. Discuss the benefits of managed care in this scenario.

2. Describe a scenario in which case management provides an effective solution. Discuss the benefits of case management in this scenario.

Answer 1

Managed Care- The term managed care describe a group of activities intended to reduce the cost of providing for-profit health care and providing American health insurance while improving the quality of that care. The primary advantage of managed care is that it provides health care solutions for people whenever they want to speak with a medical provider. Immediate services can be rendered, allowing people to take their care into their own hands with a reasonable level of certainty.

BENEFITS-

• It lowers the costs of health care.
• It lowers the costs of health care for those who have access
• Information moves rapidly within a network.
• Prescription management is much easier.

Case Managment- The National Association of State Mental Health Program Directors (NASMHPD) defines case management as “a range of services provided to assist and support individuals in developing their skills to gain access to needed medical, behavioral health, housing, employment, social, educational, and other services essential to meeting basic human services.”

Patient With HIV Infection and AIDS- Part of the case manager's linking function in working with an HIV-positive client is to educate the network of service providers, including substance abuse treatment staff, to recognize the competing demands of staying sober and dealing with the social and physical sequelae of HIV disease.  A team approach is particularly useful in combating the feelings of frustration, abandonment, grief, over-identification with the client, and anger that frequently confront professionals in this setting.

BENEFITS-

• Building a case for each patient and collecting vital information in one accessible location helps providers plan a course of action after diagnosis, provides the ability to evaluate and track treatment
• The case management process helps the insurer track treatments and coordinate care to improve quality and lower costs.

• Improve prescription accuracy and tracking, eliminate unnecessary tests and procedures, and ultimately help patients lead healthier lives.