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Executive Summary

The 7 Key Components of an Effective Case Management Methodology

Introduction: The Overlooked Value of Case Management

Case management is being overlooked as a care delivery framework with the potential to relieve three of the most significant pressures facing hospital leaders to improve clinical quality, to increase operational efficiency and to improve profitability. Furthermore, case management capabilities are underutilized in the healthcare delivery organizations and areas that need its value the most.

The pressure to improve clinical quality is increasing in intensity from the federal government, from payers and purchasers, from quality standards organizations and from patients themselves. We see this in the steep rise in regulatory compliance demands, pay for performance (P4P) contracts, clinical quality improvement initiatives and public reporting of clinical quality measures.

The pressure to increase operational efficiency is also coming from many of these same groups, as well as from the sharp increase in competitiveness in the marketplace. We see this in the increased competitiveness in terms of speed of care delivery, improvement of the patient experience, delivering more care services despite the shortage of physicians and nurses, and in the drive to differentiate our services.

The pressure to improve profitability is ever-present as hospitals and other healthcare delivery organizations must answer to investors, communities and governmental agencies. We see this in the rise in reimbursement pressures, cost and waste reduction pressures, productivity and efficiency pressures, the push to develop and implement new revenue streams and alternative care delivery models, and in the increasing demand for uncompensated care.

The purpose of this research report is to illustrate a number of ways in which hospital case management can and does produce clinical, operational and financial benefits for the organization.

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