What Is Case Management? - Definition & Role in Healthcare

Instructor: Meghan Greenwood

Meghan has taught undergraduate and graduate level science courses and has a PhD in Immunology.

This lesson will describe what case management is and how it is utilized by health professionals. The importance of this practice within healthcare will also be discussed.

Definition of Case Management

One size does not fit all. Do you recall the last time you bought shoes? Maybe you visited a store and picked out a pair that you liked. The sales associate likely had to check the back stockroom to find your size. Once you tried on the shoe and walked around the store to test them out, you may or may not have been happy with how they felt, looked, and cost. The associate may then have tried to find another size or style for you to try. These types of iterations would have continued until you were satisfied with the end result.

Now imagine that you had several associates working to fully dress you. One person was assigned to find the perfect hat, another the best fitting shirt, and yet another to determine your best hairstyle. All of this attention would help you create a sophisticated, fashionable look. And, as you can gather, that look would be different for each and every person. A fashion manager would oversee all of these associates and their fashion plan.

Case management is similar to a host of associates trying to dress you for success. However, the collaborative goal of the process is to promote individualized health and wellness. Specifically, case management includes determining the health situation of the patient, planning for and coordinating a patient's care, and finally, establishing the most economical healthcare plan for the patient and their family.

The Case Management Society of America definition for case management.
case management

The Importance of Case Management in Healthcare

When a patient enters the hospital, they are met with a whirlwind of tests, staff interactions, and paperwork. This may be overwhelming, especially for someone who is either unable to think clearly at the time and/or lacks the necessary education to fully comprehend their situation. A case manager is an important part of the healthcare system in that their main goal is to advocate for the patient. They are the direct line of communication between the patient and the health personnel who will treat them. They are responsible for determining all of the choices the patient may have and then explaining those options in an easily understandable manner. Importantly, it's recommended that each case manager interact frequently with the patient; therefore, they should not be working on more than 20 cases at at a time. Case managers are also involved with a patient's discharge and recovery, ensuring that the process is completed in a safe and timely manner.

Besides leading the individualized care of a patient, the practice of case management has general benefits to the healthcare system as a whole. These include reduced length of stay for each patient, decreased re-admission rates, and a decline in wasteful utilization of resources. Additionally, patient well-being and happiness is significantly increased when a case manager is appointed. Overall, each of these items positively impacts the healthcare system.

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