Managed Care Case Study

For the past several years, the health care and insurance industries in America have been undergoing significant reform in order to rein in the high cost of delivering health care services. Managed care has become a cornerstone of this process (Strickland, 1995). The case management industry (with its focus on cost containment, managed competition, and quality care) is playing an increasingly important role in the managed care environment (Owens, 1996). According to Mullahy (1995a), the number of case managers has risen astronomically in recent years. These individuals come from diverse professional backgrounds and practice settings that include nursing, rehabilitation counseling, and social work.
Case management, however, is not a new concept.
Private sector rehabilitation grew in response to the demand for vocational rehabilitation services by workers' compensation insurance carriers (Matkin, 1995). Federal legislation also promoted the growth of private sector case management services. albeit inadvertently. The Rehabilitation Act of 1973 gave priority within the state-federal vocational rehabilitation system to individuals with severe disabilities, causing workers' compensation carriers to seek vocational rehabilitation services for their (typically less severely injured) claimants in the private sector Habeck, Leahy, Hunt, Chan & Welch, 1991). In increasing numbers. rehabilitation nurses and rehabilitation counselors were hired to provide both medical and vocational case management services to workers' compensation
Holt, personal communication, December 1, 1996). In 1991, 29 organizations involved in the field gathered in Dallas, Texas, at a consensus meeting organized by the Individual Case Management Association. The intent was to agree upon the philosophical basis for case management, a universal definition of case management, and a set of meaningful practice standards. Eventually, a certification program for case managers was developed, including eligibility criteria and content areas for a certification examination. On July 1, 1995, the Commission for Case Manager Certification (CCMC) was incorporated as a separate, independent credentialing body. Although the process is still very young, there are already over 19,000 Certified Case Mangers (CCMs) who have completed certification requirements.
With technical and administrative support from the Foundation for Rehabilitation Education and Research, Leahy (1994) surveyed 14,078 practicing case managers representing multiple professional disciplines in a variety of work settings. His research suggested that case managers share a common knowledge base required for case management practice comprised of five factors: 1) coordination and delivery of services; 2) physical and psychosocial aspects of disability; 3) benefit systems and cost benefit analysis; 4) case management concepts; and 5) principles of community