Disease Management VS. Case Management VS. Utilization Management

Disease Management VS. Case Management VS. Utilization Management.

Utilization Management involves a nurse from the insurance carrier approving 'bed days' for a hospitalized plan member.

Case Management involves a nurse from the insurance carrier trying to reduce or stop readmission of plan members that have been discharged from the hospital to 1) Acute Rehab, 2) a Skilled Nursing Facility or 3) a Long-Term Acute Care Facility.

Disease Management involves a nurse from the insurance carrier or disease management vendor working with the patient and his or her doctors and other providers to manage a chronic disease such as 1) Diabetes, 2) COPD, 3) Congestive Heart Failure or 4) Chronic Kidney Disease.

The way VALUE should be measured for Utilization Management vs. Case Management vs. Disease Management is very different and is discussed in detail in the video with examples.

Sources:
https://www.ajmc.com/view/key-components-of-the-healthcare-system-disease-management-and-case-management

https://cmsa.org/

https://diseasemanagementassociationofamericawpan.wordpress.com/

https://www.urac.org/accreditations-certifications/accreditation-faqs/#:~:text=What%20does%20URAC%20stand%20for,plans%2C%20pharmacies%20and%20provider%20organizations.

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