Despite a plethora of resources dedicated to case management, there is no true single case management system for those with high needs. There are fragments in some systems for some issues but they do not address holistic needs. There are case management systems that are really gatekeepers for government programs. Gatekeeping has its place but it is different than case management. Despite the many areas where case management is covered (even just in the Medicaid system) there has never been a process whereby the stakeholders and government get together to at least have dialogue, if not answer the following questions:
1) Who needs what level of care management across systems? What percent are likely permanent needs?
2) What are the specific tasks needed and how much time will this take on average?
3) What are the qualifications to do these tasks?
4) What are the quality measures to assess the performance of these tasks?
5) What is the cost to perform these tasks including maximum caseload size.
6) What are the total resources now dedicated to all case management?
7) What case management are we doing now that is not useful, not necessary, or could be done at a lower level?
8) How do we create a plan to take our current system and transform to a system that provides intensive case management where appropriate and reduces services where there is no benefit?
Case management is needed in the following situations:
*People with a serious but temporary medical condition or new illness, such as cancer for help accessing and coordinating medical and other resources.
*People with long-term disabilities who are unable to do their own case management and who have no family able to assist. This must be comprehensive and include non-medical issues even the mundane daily life activities that can overwhelm some people. Even dealing with a utility company or a landlord can require assistance for people with some disabilities.
Some individuals could learn to do more of their own management with teaching (or have a family member able to take over with some training) and others will need this high level over a lifetime.
This is not a huge number of people, but the lack of case management causes them to spend a lot of time in crisis and use emergency resources from multiple organizations. Case management of this type is labor intensive and requires a very low caseload and high level of training.
This blog has interesting and depressing statistics about health care debt for our country. The main site also has some good information on credit cards, which are good, which are not, and how to think about using them. Of course most of us do not have the luxury of deciding which credit cards to use, and low-income people are often left with only the worse options (high interest, poor terms, etc.) However, now that we have the Medicaid Buy-In option and more of us are able to get and keep jobs, as we get out of poverty we can learn about things like credit card choices.
Anyway, the health care debt issue is something important.