Which statement is true about case management?
a. There are two models—traditional and full immersion.
b. It is used to reduce resource utilization only.
c. To be effective, it requires case managers to provide direct patient care.
d. It eliminates the need for other caregivers (LPN, LVNs, nursing assistants).
A
Case management is one of the strategies to reduce costs while ensuring coordination of care. The first is the traditional model, which focuses on discharge planning and determining if the care planned throughout the patient's hospital stay is necessary and appropriate (utilization re-view) so that the insurer will pay for the services. The full immersion model of case management requires the case manager to review the chart and communicate with physicians and nurses caring for the patients on their case load daily. Case managers do not provide direct patient care, and it does not eliminate the need for other health care workers (LPN, CNA). Resource utilization is the examining of resources to ensure optimal allocation, such as restructuring shifts so that nurses work fewer overtime hours is an example of resource utilization.
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