Case managers have a hard job. They are working with clients, dealing with a great amount of paper work, working with community agencies, and following rules and regulations. When managed care is a part of the equation it is much harder for the case manager due to what is and is not allowed. In this paper I will discuss managed care and how it affects the case manager’s job.
What is Managed Care?
Managed care consists of a variety of structures, processes and strategies designed to monitor, review, and guide processes of care (Mechanic, 1997). There are several types of managed care, the most popular being HMOs and PPOs. Managed care usually provides a network of providers that the client is allowed to see in order for the client to be covered. Managed care usually allows for the client to only obtain health care ...view middle of the document...
It can be very difficult for a case manager to find resources for a client with mental illness because the care they need may not be covered. To reduce costs, insurers tend to cut mental health benefits first. Because mental health varies so widely between clients, mental health costs are the most difficult to predict and are therefore very risky for managed care (Mental Health, 2008).
Those with mental illnesses can require a great amount of services including medications, counselors, therapists, or even inpatient care. Their managed care may not cover these services which could be detrimental to one with mental health issues. It is then up to the case manager to find ways to help the client, which are covered under their managed care, yet still allow the client to receive the help he or she may need.
Managed care can may it hard for a case manager to do his or her job correctly, or could cause large time delays which greatly affect the client. Managed care tends to work out better for those who are healthy and not in need of services. A case manager must have alternatives and solutions ready for times when managed care does not allow for the resources that are normally used. Managed care tends to have a large affect on the case manager and the job the he or she is trying to do.
Mechanic, D. (1997). Managed mental health care. Society, 35(1), Retrieved from http://ehis.ebscohost.com/ehost/detail?hid=4&sid=41d3ab00-7d90-41f2-87b8-f5c808c58cc2%40sessionmgr104&vid=13&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=f5h&AN=9710275047
Mental Health, . (2008). The managed care approach to health care blocks access to mental health treatment. Retrieved from http://18.104.22.168:8080/EPSessionID=c459e2c643824759bf20799cbb4d1a/EPHost=ic.galegroup.com/EPPath/ic/ovic/ViewpointsDetailsPage/ViewpointsDetailsWindow?displayGroupName=Viewpoints&prodId=OVIC&action=e&windowstate=normal&catId=&documentId=GALE|EJ3010054255&mode=view