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The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self determination.
Continuity of health care (also called continuum of care [3]) is to what degree the care is coherent and linked, in turn depending on the quality of information flow, interpersonal skills, and coordination of care. [4] Continuity of health care means different things to different types of caregivers, and can be of several types:
Essential for the implementation of the integrated care program is a framework that guides the process. In Ireland, the Health Service Executive (HSE) is implementing an integrated care program according to a 10-Step Framework. [13] This Framework is created along the recommendation of the World Health Organization. [14] [15]
The first part focusing on basic concepts was published as a European Norm in 2007. [3] It was prepared by working group 2 of CEN TC251 - Health Informatics.Work to take the standard through ISO and to develop a second part focused on the healthcare process had proven problematic, resulting in the withdrawal of the two ISO work items on 13 January 2011 [4] and a proposed resolution in CEN ...
The term has sometimes been used in a broad sense with reference to managed care in general (as opposed to fee-for-service care), but in the United States it now more often refers to any specific network of health care organizations constituting a corporate group that attempts to integrate care to some degree (that is, to coordinate the patient ...
These indicators supply health care leaders with data to evaluate the organization’s performance in order to design strategic QI planning. The indicators are limited to 13 non-disease specific measures that provide system-level indications of quality, applicable to both inpatient and outpatient settings and across the continuum of care.
Driven by better-than-expected results during the Medicare annual enrollment period and a program expansion in Medicaid, we are lifting our full year 2025 revenue guidance by $4 billion ...
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...