Case Management and Home Health Care: An Integrated Model

Abstract

This article presents a model of integration of home health care and case management programs, designed to improve outcomes and reduce cost. Components of screening mechanisms, interventions, and outcomes are described. Financial methods for funding such a model are discussed as well as how to position and market this type of program to managed care organizations. Preliminary results of such a program implemented in a staff model HMO demonstrate reduced beddays, increased memberlphysician satisfaction, high quality outcomes, and cost effectiveness.

Infinicare framework for integrated understanding of health-related activities in clinical and daily-living contexts

“…Health care delivery practices have changed in response to fragmented care delivery services (Chassin & Galvin, 1998;Medicine IOMIo, 2001), increased pressure for earlier discharge, transformation of daily-living contexts (e.g., home, community) into primary settings for health (Aliotta & Andre, 1997;Wagner et al, 2001), increased clinical and home use of health information technologies (HIT) (Brennan, Downs, & Casper, 2010;National Center for Health Statistics, 2009;Koch, 2006), and increased patient-engagement expectations (Carman et al, 2013;Gruman et al, 2010). Consequently, health-related activities are not bounded within hospitals or clinics.…”

Neal Theory of Home Health Nursing Practice

“…The delivery of patient care is increasingly taking place in home settings requiring home healthcare nurses to provide skilled, efficient care within a short period to patients with complex and chronic illnesses (Aliotta & Andre, 1997). Today, the demands placed on the practice of home healthcare nurses by changes caused by altered reimbursement patterns, integrated networks of delivery, use of new technology, and use of new outcome and quality measurement systems significantly affect home healthcare nursing practice.…”

Goals of Home Care

“…Some authorities suggest that a model that combines therapeutically driven health interventions and a much fuller use of nonprofessional personnel will be the hallmark of effective home care in a managed care system. Suggesting this kind of integration, Aliotta and Andre (1997) also foresee care management as emanating from the health clinic primary care teams rather than home health agencies. Although not suggested directly by the authors, this model might permit nurses and nurse practitioners attached to the clinics to offer general oversight to line home care workers and PAS workers, bypassing home health agencies (Gann, 1997).…”