Case Management in a Health Maintenance Organization

Abstract

The planning and implementation of this case management model brought together a mul-tidisciplinary team with a common goal of providing a positive health care experience for the injured worker. The challenge of implementation of a case management model within a large, complex health care system has resulted in successful changes. For example, referral tracking has been improved due to the expected outcome of quality case management. The difficulties encountered due to the previous lack of consistency in occupational services within the seven occupational health clinics became an immediate concern with the implementation of the model. The formulation of the Standard Operating Procedures became a priority focus. Inconsistencies in service delivery have been identified and corrected by the development and implementation of regionally driven Standard Operating Procedures. Complex group process and interdepartmental communication efforts have resulted in more standardized health care for the clients. Community outreach with employer groups has been enhanced, providing a close liaison with the occupational health care team. Improved information exchange assists in ongoing monitoring of complicated cases and earlier problem resolution. The projected outcome is improved quality of care for the injured worker and a return to an optimal state of health and productivity.