tion of the issue. An important characteristic of most HMOs is that the amount of payment for the health care services to be delivered is set before the services are delivered to the patient. This approach to compensation for services means that compensation for the services provided to all patients suffering from a specific problem, as an example colon cancer, will be the same. Within the group of patients suffering from colon cancer, however, some will require more services than the average, while others will require less services than the average. The critical problem for an HMO in this illustration is to assure that the planned average level of compensation is not exceeded in actual practice for all colon cancer patients. One approach to solving this problem is case management.
Case management is the term used to describe the practice of micro-managing the care provided for specific patients or classes of patients. The intent of case management is to minimize the costs associated with care without compromising the quality of care·objectives that critics of case management contend are incompatible with one another. Nevertheless, in a managed care environment, cost control assumes increasing importance, and case management is one of the practices employed to attain cost control.
Implications of the issue for management. Case management programs are valuable parts of an HMO's activity (Huffman & Johnson, 1994, p. 52). A case manager serves as a coordinator for all medical services and works with the treating physician and other appropriate personnel who either are a part of an HMO or are from organizations providing support to the HMO.
Unlike more routine managed care techniques, such as pre-admission certification and continued-stay review, the real value of high-cost case management lies in identifying the relatively small number of catastrophic claims that account for a disproportionate share of health care expe...