Paper Example on Case Management and Health Care Reform

Introduction

Substantial literature evidence supports case management as being an effective way of boosting care for patients having complicated healthcare needs. The healthcare reforms have been under discussion for several years mainly at the state, federal and the local levels at large (Clark, 2015). Despite its unclear parameters until recently, there is at least an indication of it is coming to focus. Marti et al. (2016) argue that changes that were enforced by the Affordable Care Act and the value-based purchasing agenda adversely will affect reimbursement in the entire continuum of care. The Medicaid and Medicare services are showing an indication of moving far away from passive to an active purchaser of care services and products that are value-based (Hall & Griner, 2015). The healthcare value is, therefore, being restructured. Quality is therefore viewed as being a composite of the outcome of the patient, patient experience and safety. It, therefore, means that the overall cost of all purchasers of care is the payment. Hall and Griner (2015) argue that the pronounced change form quantity to quality is a typical shift for the providers for healthcare. In the past, the hospitals used to submit charges to the insurer and got paid for the services that they provided with minimal questions tailored to them but later, a shift happened to the inpatient prospective payment system from charge based payments to systems making use of diagnosis-related groups to establish care rate payment. In this model, we are going to have a close look at the literature concerning the case management for HIV/AIDS clients to help establish the effectiveness of case management for this given population of clients. Besides, we are going to examine if there is a factor related to population that affects strategies of case management and how the factors can be manipulated to enhance case management.

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Effectiveness of Case Management for HIV/AIDS Clients

Reduced Mortality Rate

Case management has positively impacted on the lives of the HIV/AIDS clients. The main aim of case management is to serve individuals living with HIV/AIDS with numerous and complex health-related and psychological needs (Marti et al., 2016). The model is mainly structured to serve persons who might need longer period investment and for those who accept an intensive level of case management service provision. This makes such individuals live for long since deaths that were earlier associated with ignorance and inability to access adequate healthcare are eliminated by the case management best practices (Clark, 2015). Furthermore, the reduced mortality rate is attributed to increased access to medical care, social services, and prescription medications. The case management also focuses on the teaching about the best nutritional requirements that are vital in boosting the immune system hence improving the living standards of the HIV/AIDS clients.

Reduced Cost and Healthcare Use

Case management program's main aim is to reduce the cost of healthcare services and promote service delivery to patients even in remote places. The frequent follow-ups, contact, social services, increased access to medical care and prescription medication has made many clients to receive healthcare services even from their home (Marti et al., 2016). This has therefore greatly helped in reducing the number of people being admitted to healthcare facilities (Clark, 2015). The HIV/AIDS clients are therefore able to receive the same services before their conditions can get worse hence reducing admission cases. It, therefore, goes without emphasis that case management has been very effective in reducing the use of health care resources as well as reducing the healthcare costs.

Factors Influencing Case Management Strategies

Public Stigma

Studies have revealed that most chronically ill persons in any given community must have not obtained the service they need and this can be because either the services are not existing or just because they are not ready to disclose their status. Marti et al. (2016) argue that this results in the unmet needs of the chronically ill individuals hence calling for the development of a framework for a network of the essential services and awareness creation. Some clients living with HIV/AIDS have been resistant to case management programs presented to them as they fear that the public may easily know their HIV status just as a result of them being seen as taking an active role in the case management program activities (Hall & Griner, 2015). This results in an adverse impact on case management strategies as it makes it difficult to meet the case management best practices and goals.

The case management strategies will have no meaning if the individuals whose needs are to be addressed are resistant and not ready to participate in the processes relating to case management. The case management program will, therefore, be effective only if the clients are ready to undergo direct involvement in the case management programs (Clark, 2015). People living with HIV/AIDS, therefore, have to be educated on the importance of openness and participation in any activities that are aimed at boosting their well-being. This ensures that health provider gets an easy time in collecting the necessary information that will be needed to enhance the welfare of HIV/AIDS clients.

HIV/AIDS Education

Research reveals that most patients have inadequate knowledge concerning HIV/AIDS. Most patients have little information about transmission routes (Clark, 2015). Most HIV/AIDS patients who have a low level of education have a belief that anti-HIV treatment completely prevents the transmission of the virus and this is attributed to the reason why most of them prefer having unsafe sex (Marti et al., 2016). The amount of information that a patient has about the transmission of the disease is very vital in preventing secondary risks and the risks of transmission to other individuals. This, therefore, calls for educating the HIV/AIDS patients to eradicate the misconception regarding HIV/AIDS. Hall and Griner (2015) argue that this will have an overall effect of reducing the risk of engaging in the risk-taking practice hence the reduced spread of the virus. There is also a need to inform the family members about HIV/AIDS and the best way to handle and live with people infected with the virus. This will ensure a smooth coexistence between HIV/AIDS patients and their environment.

Furthermore, apart from HIV/AIDS education, patients need to be counseled. The need to be informed that living with HIV/AIDS is the end of the world and that one can still live for long as long they adhere to HIV/AIDS best practices and medical prescriptions as prescribed by the healthcare providers (Marti et al., 2016). The patients, therefore, need to acknowledge the importance of disclosing their HIV/AIDS status to the public and taking an active role in a program tailored to people living with HIV/AIDS. Moreover, the patients need financial support especially for those who are not financially stable. This enables them to meet their daily financial obligations.

Conclusion

Case management has been used as an effective tool for boosting care for patients with complicated healthcare needs such as people infected with HIV/AIDS. The pronounced change form quantity to quality is a typical shift for the providers for healthcare (Clark, 2015). Case management has made sure that there is increased access to medical care, social services and prescription medications (Marti et al., 2016). The current study of providers of healthcare shows that case management for people living with HIV/AIDS is migrating to a model considered as a healthy home. The case management has made it easy for individuals who were not able to receive health care to be in a position to equally receive health hence bettering their lives. Clark (2015) argues that this has resulted in the restructuring of health care hence making quality to be viewed as being a composite of the outcome of the patient, patient experience and safety. This makes the case the benefits of case management emphasized.

References

Clark, M. (2015). Population and community health nursing (6th ed.). Prentice Hall.

Hall, W., & Griner, P. (2015). Cost-Effective Health Care: The Rochester Experience. Health Affairs, 12(1), 58-69. doi: 10.1377/hlthaff.12.1.58

Martin, F., Caramlau, I., Sutcliffe, P., Martin, S., Bayley, J., & Choudhry, K. (2016). Self-management interventions for people living with HIV/AIDS. Cochrane Database Of Systematic Reviews. doi: 10.1002/14651858.cd008731