Cost Control and Quality

Chapter ten of our text outlines external controls of long term care. One of the issues that presents a potential problem as stated in our text is management of care. This section discusses the balance that is attempted by the healthcare spectrum to equally control quality, access, and cost. However, it is often times difficult to manage all three without compromising one.
One of the examples the text used was the case management method. In case managment a managed care organization may assign a case manager to a patient if the qualifications have been met. The text does point out an important fact though, case management may provide the patient with high quality care, but at the same time may sacrifice efficieny due to the high costs associated with this personalized method of care.
Due to the expense of case management, MCOs are reluctant to qualify enrollees for this type of service. In fact, as stated on the Blue Cross Blue Shield website for Florida, patients are required to submit a case management referral form to their primary physician. Once this form has been completed by the physician it is then sent back to the MCO provider and reviewed for the patient's possible eligibility. Of course, the patient in question must been certain eligibility criteria.
The main focus and objective of case management utilization is, of course, to save money...however, this does not always occur. Assigning a case manager to a patient is strictly based on patient need for a reason. It is costly, not only for the patient, but for the provider, and healthcare facility to assign a case manager for individual patients. On the other hand, it may be beneficial for the provider in terms of cost by deciding just how long and what types of services this patient should be eligible to endure. There are many types of cost control methods in long term care, the above mentioned just happens to be one of the more popular ones. Eventually a cost control method will need to be put into place that can accurately manage quality, access, AND control.