What Is The Impact Of Case Management On Medical Cost Reduction In Healthcare Companies?

Abstract

For healthcare insurance companies, managing and reducing medical costs is important to remain viable and/or meet investors and stakeholder expectations. The accountability to minimize costs and remain competitive becomes a responsibility for managers who work in these companies. Therefore, managers must continually look for methods to identify and implement opportunities that improve case management business processes. In this research study, the focus is on the question ‘what is the impact of case management on medical cost reduction in healthcare companies? This is asked within the context of business processes and leverages the four principles of Taylor’s scientific management theory. By investigating the relationship between case management processes in healthcare insurance companies and medical costs, the integrated synthesis uncovers that although evidence exists that case management does reduce medical costs, there is insufficient research on how to improve case management processes. There is an opportunity to provide recommendations on approaches and techniques to improving case management processes to reduce medical costs. Improving case management processes should include quantitative analysis. The proposition is that as case management processes improve and become more efficient, and when targeted against the right population, medical costs for healthcare insurance companies are reduced thereby improving the financial position of healthcare insurance companies. Therefore, managers who understand and know how to improve case management processes in healthcare insurance companies contribute more towards the financial position than companies who do not have the right management.