Case Management: Lessons from Integrated Delivery to Promote Quality Care to the Elderly

Abstract:     
The elderly population has specific needs that include coordination of complex chronic disease, diverse social services, and non-health care assistance. However, the Medicare program, the primary insurance program for the elderly, only provides incentives for disjointed, uncoordinated care that results in inappropriate, inefficient, and potentially risky conditions being shouldered by its vulnerable beneficiaries. Case management in integrated delivery systems has been shown to be effective in coordinating elderly clinical and non-clinical needs. These include acute care clinical requirements, chronic disease(s) management, long term care services, and home health as well as end of life services. Medicare, however, does not currently cover case management providers for these purposes. Case management should be a covered service under the traditional Medicare individual provider payment scheme to improve the efficiency of the Medicare program, and, more importantly, to move the Medicare program to a true patient-centered model that respects and empowers the elderly to allow them independence and function for the duration of their lives.

Keywords: elderly, case management, Medicare, integrated delivery

JEL Classification: I18

Accepted Paper Series