Managed care vs. case management: What you need to know

| October 15, 2024

Discover how each plays a unique role in guiding patients through their healthcare experience

Managed care and case management are healthcare strategies designed to enhance the delivery and efficiency of services. While they share a common goal of improving patient outcomes and optimizing resources, they serve different purposes and are implemented in different ways.

Managed care is a healthcare approach that focuses on controlling costs and ensuring access to quality care through a network of providers. At the same time, case management is a personalized approach that helps patients navigate their healthcare journey. Keep reading to learn more about how they differ and how they contribute to better healthcare experiences.

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What is managed care?

Managed care is a healthcare system designed to control costs and improve care quality by coordinating healthcare financing and services through a network of providers [1]. Managed care organizations (MCOs) are health care providers or plans that prioritize controlling costs while maintaining high-quality care through the managed care model.

The approach’s key components include:

  • Preventive care: It manages chronic conditions and focuses on early interventions to reduce hospitalizations, invasive medical interventions, and other higher costs associated with complex procedures.
  • Primary care providers: Providers oversee and coordinate patients’ medical care, making them central to managing patients’ overall health.
  • Provider networks: Group of credentialed healthcare professionals and facilities—such as doctors, hospitals, imaging centers, pharmacies, and more.

By streamlining access to services, managed care promotes better health outcomes, cost savings, and a more sustainable healthcare system.

Learn more:
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What is case management?

Case management is a collaborative process designed to coordinate a patient’s healthcare needs, especially those with complex or chronic conditions. Led by a case manager, it involves planning, monitoring, and organizing care to ensure patients receive the most appropriate and efficient treatment [2]. The case manager works closely with the patient, their family, and a team of healthcare providers to create a personalized care plan that addresses the patient’s unique needs and goals.

This is done by facilitating communication between healthcare providers, arranging follow-up appointments, and managing transitions between different levels of care. Key aspects include:

  • Patient identification and eligibility determination: identifying patients needing case management services and establishing a connection between them and a case manager.
  • Assessment: understanding the patient’s healthcare and social needs, capabilities, and available resources.
  • Care planning and goal setting: developing a treatment plan with defined goals, necessary actions, services, and targeted outcomes.
  • Plan implementation: setting the care plan in motion.
  • Plan monitoring: providing ongoing feedback throughout the care process while evaluating and assessing progress at specific milestones.
  • Transition and discharge: preparing patients to move to other facilities or the completion of the case management process when goals are met.


What are the four types of case management?

  • Brokerage case management: the case manager primarily connects patients with necessary services and resources. This approach is more hands-off and focuses on linking patients to the proper support.
  • Clinical case management: involves direct interaction between the case manager and the patient, focusing on the patient’s medical and mental health needs. The case manager provides ongoing support, monitoring, and counseling while coordinating treatment plans, often as part of a clinical team.
  • Strengths-based model: it emphasizes the patient’s strengths and abilities rather than focusing solely on their needs or problems. The case manager helps the patient leverage their skills and resources to take an active role in managing their care.
  • Intensive case management: it is used for patients with severe or high-risk conditions, such as chronic mental illness or substance abuse. This model provides more frequent, hands-on support and close supervision, with case managers working intensively to coordinate comprehensive services, often involving crisis intervention and long-term care planning.

Related resource:
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Managed care vs. case management

While both managed care and case management aim to improve healthcare delivery, they differ in scope and focus. Managed care is a broader system that oversees healthcare networks to control costs and ensure access to quality care. It operates on a large scale, managing healthcare expenses by working with a network of providers.

In contrast, case management is a more personalized approach tailored to the individual needs of patients, particularly those with complex or chronic conditions. A case manager works closely with the patient and their healthcare providers to coordinate all aspects of care, ensuring it is comprehensive, timely, and efficient.

While managed care is primarily concerned with controlling costs on a systemic level, case management focuses on improving health outcomes by ensuring the quality and coordination of care for individuals and addressing specific health challenges.

How we can help

At WeCare tlc, we offer comprehensive support for both managed care and case management through our onsite clinics and near-site clinics. Our health centers are designed to help employers manage healthcare costs by providing high-quality care within a controlled network, ensuring access to preventive services and efficient care.

Additionally, our case management services focus on personalized care coordination for employees with complex or chronic conditions, improving health outcomes and reducing hospitalizations.

Learn how WeCare tlc can enhance your healthcare strategy.
Contact us today and discover the benefits for your organization.

Sources:
1. National Library of Medicine | Managed Care

2. National Library of Medicine | Case Management

3. National Library of Medicine | What Is Case Management? A Scoping and Mapping Review