Q&A: Case management model components

Q. What should case management directors consider when implementing a case management model?

A. Case management models have at least seven fundamental components, regardless of the type of hospital, payer mix, physician structure, etc. The system director of case management has to implement and strategically engage all of these fundamental components:

• Role of the director or manager
• The written utilization review (UR)/case management plan
• The UR committee
• Scalar process: the creation of levels of authority in the department’s hierarchy, followed by the division of labor in which a job is broken into pieces and assigned as responsibilities
• to specific personnel
• The physician advisor/medical director of case management
• National standards for hospital case management
• Philosophy of the case management service

For more information, see Case Management Models: Best Practices for Health Systems and ACOs, Second Edition.

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