Case Management Philosophy and Guiding Principles

 

Case Management Philosophy and Guiding Principles

Case management is a specialty practice within the health and human services profession. Everyone directly or indirectly involved in healthcare benefits when healthcare professionals and especially case managers appropriately manage, efficiently provide, and effectively execute a client’s care. The underlying guiding principles of case management services and practices of the CMBOK follow:

  • Case management is not a profession unto itself. Rather, it is a cross-disciplinary and interdependent specialty practice.
  • Case management is a means for improving clients’ health and promoting wellness and autonomy through advocacy, communication, education, identification of service resources, and facilitation of service. Case management is guided by the principles of autonomy, beneficence, nonmaleficence, and justice.
  • Case managers come from different backgrounds within health and human services professions including nursing, medicine, social work, rehabilitation counseling, workers’ compensation, and mental and behavioral health.
  • The primary function of case managers is to advocate for clients/support systems. Case managers understand the importance of achieving quality outcomes for their clients and commit to the appropriate use of resources and empowerment of clients in a manner that is supportive and objective.
  • Case managers’ first duty is to their clients – coordinating care that is safe, timely, effective, efficient, equitable, and client-centered.
  • Case management services are offered according to the clients’ benefits as stipulated in their health insurance plans.
  • The Case Management Process is centered on clients/support systems. It is holistic in its handling of clients’ situations (e.g., addressing medical, physical, emotional, financial, psychosocial, behavioral, and other needs), as well as that of their support systems.
  • The Case Management Process is adaptive to case managers’ practice settings and the settings where clients receive health and human services.
  • Case managers approach the provision of case-managed health and human services in a collaborative manner. Professionals from within or across healthcare organizations (e.g., provider, employer, payor, and community agencies) and settings work together closely for the benefit of clients/support systems.
  • The goals of case management are first and foremost focused on improving clients’ clinical, functional, emotional, and psychosocial status.
  • The healthcare organizations for which case managers work may also benefit from case management services. They may realize lowered health claim costs (if payor-based), shorter lengths of stay (if acute care-based), or early return to work and reduced absenteeism (if employer-based).
  • All stakeholders benefit when clients reach their optimum level of wellness, self-care management, and functional capability. These stakeholders include the clients themselves, their support systems, the healthcare delivery systems including the providers of care, the employers, and the various payor sources.
  • Case management helps clients achieve wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, service facilitation, and use of evidence-based guidelines or standards.
  • Based on the cultural beliefs, values, and needs of clients/support systems, and in collaboration with all service providers (both healthcare professionals and paraprofessionals), case managers link clients/support systems with appropriate providers of care and resources throughout the continuum of health and human services and across various care settings. They do so while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable. This approach achieves optimum value and desirable outcomes for all stakeholders.
  • Case management services are optimized when offered in a climate that allows direct, open, and honest communication and collaboration among the case manager, the client/support system, the payor, the primary care provider (PCP), and all other service delivery professionals and paraprofessionals.
  • Case managers enhance the case management services and their associated outcomes by maintaining clients’ privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards and guidelines, as appropriate to the practice setting.
  • Case managers must possess the education, skills, knowledge, competencies, and experiences needed to effectively render appropriate, safe, and quality services to clients/support systems.
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