Why is Case Management necessary? How can a nurse know what is better for a patient than the patient’s physician?

The U.S. health system is anything but a "system." It is a multitude of providers all functioning independently without any coordination. Because most patients in Case Management are in the active care of several independent providers, these patients are those most likely to suffer from this lack of provider coordination. The Case Manager assumes this role as "coordinator," assisting patients and providers in developing a collaborative approach to their care. The Case Manager’s efforts assist in cost containment by PPO channeling, minimizing the chances of duplicate testing, rate negotiation, appropriate hospital stays, discharge planning, etc.

How does the patient/insured react to Case Management?

When a person is facing a medical situation that has caused them to be considered for Case Management, they are often overwhelmed by the prospects facing them. ACM Case Managers assume the necessary role of patient advocate. We work with patients to educate them on both the illness and treatments and how they can best utilize and stay compliant with their health care benefits. ACM assists patients in the development and understanding of their "roadmap" to care. We find that patients in ACM Case Management embrace the program and often find it to be one of the most valued benefits of their health care coverage.

Is ACM able to get providers to cooperate with Case Management efforts?

Providers are normally agreeable to the Case Management process. In much the same way patients are assisted in coordination of their overall care, the providers enjoy many of the same benefits. Additionally, it also allows the provider a central contact point with the insurer to better determine and comply with the patient’s health care benefits; therefore, avoiding potential reimbursement issues.