WHAT IS CASE MANAGEMENT ?
“a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes’.
“Rouchetta Case management is a procedure to plan, seek, and monitor services for different service providers and staff on behalf of a client. Rouchetta takes primary responsibility for the patient and assigns a case manager, who coordinates services, advocates for the patient, controlling and managinghis available resources and streamlining his purchase of healthcare services. The procedure allows Rouchetta, to ensure premium safe standardized cost-effective healthcare service provision utilizing the streamlined coordinated efforts of Rouchetta’s professional Healthcare network.
Rouchetta Case management office is a managed care technique within our health care coverage system. It involves an integrated system that manages the delivery of comprehensive healthcare services for enrolled patients.Professional, well trained, case managers are employed in almost every aspect of health care and these adopt different approaches in the control of clinical actions required.
Case management focuses on delivering personalized services to patients to improve their care, and involves four steps:
For individual out-of-pocket spending patients;
1) Preparation of the patients electronic medical record and ensuring its completion.
2) Proposing a care delivery plan.
3) Evaluation of the diagnostic results & channeling / deployment and follow-up on the execution of the care plan accordingly.
4) Evaluation of overall care program effectiveness &proposing an adjustment of the program if required.
5) Second medical opinion when required.
Employer / corporate patients setting
Case managers working for employers typically act as gate keepers and do the following:
1) Verify medical reasons for employee absences.
2) Follow-up reporting after absences from work due to poor health.
3) Provide health education.
4) Assist employees with chronic illnesses.
5) Provide on-site wellness programs.
6) Assist employees to seek specialized treatment when need arises.
Health care provider setting
Case managers working with health care providers act as patient coordinators and typically do the following:
1) Verify coverage & benefits with the health insurers to ensure the provider is appropriately paid.
2) Coordinate the services associated with discharge or return home.
3) Provide patient education.
4) Provide post-care follow-up and reporting.
5) When required, coordinate subsequent / future visits and services with health care providers to ensure the application of a sustainable managed care model.