Case managers play critical roles in ensuring appropriate and efficient delivery of health care services to the clients and individual groups of people. The case management process is connatural to the nursing process although it has less additional components. Services offered by the case management are limited and hence only specific clients benefit (Bourgeois, 2014). As a result, there has to be a process of identification and selection of the clients to benefit. A case manager, educates, empowers, co-ordinate care, falcate communication, plans and assess the needs of the clients. Although case managers perform various functions utilizing their competencies, they cannot work in isolation to ethical and legal issues facing Population Health Management.
Functions of Case Managers
A case manager plays various roles. First, the case manager encourages the use of appropriate health services. The manager disseminates information to the entire population and largely to the individual clients on how to utilize the available health care services. For instance, the case manager educates patients about the symptoms of asthma or a group of clients about diabetes and the measures they can use to control the spread of the disease. Secondly, the case manager provides assistance on transitions from one level of care to another (Clark, 2015). The managers ensure that the transitions are smooth and an example include the development of a discharge plan for various patients with different complications. Thirdly, the case manager ensures that the flow of information is smooth among the various members of the healthcare team and to the families and patients. Fourthly, the case manager ensures the delivery of care is coordinated without a seam and that the needs of the patients are met successfully (Cohen, Amarasingham, Shah, Xie & Lo, 2014). The fifth role of the case managers is educating the healthcare providers, families, clients, public and agencies, on matters involving the healthcare and interventions that promote informed decision-making process. The fifth role includes empowering the populations, and the patients to be diligent in solving engaging in self-advocacy. Other roles of case managers include joint advocacy, encouraging appropriate use of health care services, promotion of self-advocacy and self-determination, and giving assistance to the transitions from one level to another.
Competencies of Case Managers
The changing paradigm in the health care sector as a result of dynamic and complex needs of clients, prompts the case managers to be more competent in skills to be able to effectively manage practices at population, family and individual level (Bourgeois, 2014). Imperatively, the activities of case management are inclined towards meeting the needs of the clients and their caretakers. In this regard, collaboration with the families, clients and the health care providers is essential. To achieve their mandate, the case managers incorporate the principles of behavioral change and ensures that communication is effective among the various healthcare providers, clients, and managers. The achievement of quality services is the goal of every case manager and to achieve outcomes of high quality, competence is inevitable. Expertise in clinical knowledge compels the case managers to execute their roles effectively to the community members (Cohen et al., 2014). Such knowledge necessitates proper usage of the community resources. Moreover, the case managers incorporate evidence-based practice strategies in the delivery of quality community-based services. Besides, a case manager needs to be conversant with the operations of the organization, the legal, and professional standards which facilitate the better performance of services and creative use of constrained resources. The case managers work within a given community and they have to interact with the locals for effective service delivery. In this regard, they must possess cultural sensitivity competency and be in a position to engage with the local people responsibly. Patient-centered care requires that the providers be integrated into the community where the patients and families originate. Elsewhere, ethical advocacy is a key competency that the care managers should possess when dealing with the clients in a community-based setup. Ethical advocacy creates a balance between health care systems and joint advocacy (Cohen et al., 2014).
Ethical and Legal Issues Affecting the Population Health Management
The ethical and legal issues affecting the Population Health Management include the patient autonomy, privacy of the patient, patient consent, fair allocation of resources, breach of contract, negligence, denial of services, confidentiality, distributive justice (fair allocation of organs) and procedural justice (Clark, 2015).
As a result of increased demand for health care services, the limited resources become constrained. In addition to resources being constrained, the insurance coverage for health services also become constrained. In this regard, the payment for case management services for the population groups and individual clients are restricted.
As a result of limited resources, issues on a fair allocation of resources in regard to gender, age, and socioeconomic status becomes an issue. Case managers play the role of allocating the resources fairly to enable efficient delivery of services. However, since resources to be allocated are limited, the case managers tend to allocate available and limited resources unfairly. In this regard, case managers tend to minimize service frequency in order to allow them to offer care services for a long period of time in regard to the needs of the clients (Cohen et al., 2014).
With limited and constrained resources, case managers tend to violate system rules so as to meet the needs of the clients and the needs appropriate to the client needs. This leads to other ethical issues such as client autonomy and client rights to services. Moreover, the clients tend to engage in unhealthy behaviors such as the refusal of services (Clark, 2015).
Legal issues include the breach of contract and denial of services. Case managers breach the contracts they have with the clients while the clients may also defy the terms of clients. As a result, the clients deny the services provided by the case managers leading to a legal crisis (Bourgeois, 2014).
In conclusion, there are various ethical and legal issues facing the Population Health Management include the patient autonomy, privacy of the patient, patient consent, fair allocation of resources, breach of contract, negligence, denial of services, confidentiality, distributive justice (fair allocation of organs) and procedural justice. It is upon the case managers to ensure that the services they provide meet the requirements and set guidelines without breaching the terms. Unethical behaviors come with serious complications to the delivery of health care services. A case manager plays various roles and these include assessing the clients' needs, plans how to meet the needs of the clients, ensures smooth communication, co-ordinate the provision of care, educates the clients, agencies, families, and empowers the populations and clients.
Bourgeois, D. T., (2014). Information Systems for Business and Beyond. Saylor Academy
Clark, M. (2015). Population and community health nursing (6th ed.). Upper Saddle River, NJ: Pearson.
Cohen, I., Amarasingham, R., Shah, A., Xie, B., & Lo, B. (2014). The Legal And Ethical Concerns That Arise From Using Complex Predictive Analytics In Health Care. Health Affairs, 33(7), 1139-1147. doi: 10.1377/hlthaff.2014.0048
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