Case managment model-4 Case Management Models | Grace College

A further look into case management roles, functions, models, and case loads. We also will discuss the state-of-the-art staffing ratios needed to support the various models. The prospective payment system for Medicare patients initiated the need for hospital staff to begin to think differently about how they organize and deliver care. Because hospitals would now be paid one fee for the entire stay, managing length of stay and cost containment became new necessities for hospitals. Gone were the indemnity reimbursement methods under which hospitals had operated.

Case managment model

Case managment model

Case managment model

Case managment model

Case managment model

Single Article. Intensive Case Management Intensive case management ICM provides assertive outreach and counseling servicesincluding skills-building, family consultations and crisis intervention, according to the Journal of Psychoactive Drugs. In the dyad model, the social worker may be responsible for some of the discharge planning functions, or may be solely responsible for psychosocial assessments and interventions, with discharge planning completely under the responsibilities of Hhs cheerleaders nurse Case managment model manager. Data collected once for multiple purposes. This site uses Akismet to reduce spam. The need Case managment model relate patients' clinical issues to their level of care and their discharge plan, drove this change forward. Can be frustrating for staff to manage.

Fur older mature. Overview of Case Management

Advances in Medical Sociology. Health care utilization of chronic inebriates. Also, other sources of bias may have obscured the differential effectiveness of this intervention. Following is a profile of the model in which consumers choose their case managers, as it is applied in Dane County, Wisconsin also see Table 1. While not part of this study, several of the newer case management newsletters appear robust and may be useful to several library Case managment model. Nursing case management. Following is a profile of how New Jersey is meeting the challenge of shrinking resources also see Table 1. Conclusion: Collections that support case management require Sexy girls on boats relatively small group of core journals. A few Case managment model use other system structures, such as private case management agencies, contracted independent non-profit entities that provide case management either regionally or statewide, mixed public and private systems, and case management through service provider agencies. Case managment model substance abuse treatment with case management: its impact on employment. The Quality Framework not only requires quality assurance systems to gather quality-relevant data, but also that the data be used to improve the quality of services. The role of case management in substance abuse treatment services for women and their children. Br J Community Nurs.

Despite the best intentions of leadership, many case management models in place today fail to efficiently serve the best interests of patients, staff, or the organization.

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  • Case management has been implemented in substance abuse treatment to improve cost- effectiveness, but controversy exists about its potential to realize this objective.

One such integrated care management team approach has helped a health system improve clinical outcomes for patients, lower costs, and lower rates of healthcare utilization, according to a year study. The rate was This resulted in a higher rate of diagnosis for active depression. For patients in team-based practices, the depression rate was Adherence to diabetes care protocols also was higher for patients in team-based practices.

Nearly six times as many patients in the team-based practices had a documented self-care plan The nurse care managers provide care management based on the integrated team-based care model. It combines mental health integration and medical home. The nurse care manager develops holistic care plans, educates patients, and talks with patients about mental health issues, as needed.

In a primary care provider clinic, a medical assistant who has received additional training assists patients with their medication, Reiss-Brennan says. Health advocates are certified with medical training. The role of a care guide can be handled by a trained layperson. The care guide helps patients, families, and care teams navigate the healthcare system. When patients arrive at their community provider, one team member meets with the patient and family and helps them navigate the first step.

Association of integrated team-based care with health care quality, utilization, and cost. Reprints Share. Related Products Case Management Insider: The full scope of case manager and social workers roles, functions, models, and caseloads Single Article. Which patients will pay, which are time-wasters? Single Article. Patients receiving integrated care management have a consistent experience across disciplines. Report Abusive Comment. Restricted Content You must have JavaScript enabled to enjoy a limited number of articles over the next days.

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Its multidisciplinary articles relate to both nursing and social work. This Policy Research Brief describes case management models, innovations, and best practices identified for this project. In addition to its excellent coverage, it is both free of charge and readily available. Peer review was postulated as a minimal guarantee for the quality of the selected studies and seemed an appropriate starting date, since no evaluation studies were published before that date in these types of journals Mejta et al. Following are profiles of this model as it is implemented in these two States. However, no randomized and controlled study has yet shown its effectiveness compared with other interventions. Similarly, intensive case management applies the same principles, usually with a smaller caseload and without a team approach.

Case managment model

Case managment model

Case managment model

Case managment model

Case managment model

Case managment model. 2. Strengths-Based Case Management

Intensive case management ICM provides assertive outreach and counseling services , including skills-building, family consultations and crisis intervention, according to the Journal of Psychoactive Drugs.

It is similar to and sometimes grouped with assertive community treatment, a case management model that utilizes a team approach and larger caseloads. Strengths-based case management is a perspective originally developed to help a population of persons with persistent mental illness make the transition from institutionalized care to independent living, according to Comprehensive Case Management for Substance Abuse Treatment from the Substance Abuse and Mental Health Services Administration SAMHSA.

There is some evidence that suggests strengths-based approaches can improve social connections, have a positive psychological impact and enhance well-being, help children and families, and improve retention in treatment programs for those who misuse substances. Ongoing monitoring is not provided or is relatively brief.

This approach is also appropriate in instances where treatment and social services in a particular area are relatively integrated and the need for monitoring and advocacy is minimal. One example of this is how case managers in a large metropolitan area were able to link HIV-infected clients with at least two referrals during the initial session to agencies or services that would provide ongoing services.

Case managers working with substance-abusing clients in a large metropolitan area had access to funds and were able to purchase treatment services, drastically reducing waiting periods. Clinical approaches to case management combine resource acquisition case management and clinical therapy activities. Clinical and rehabilitation approaches are often combined, as some case managers provide activities like psychotherapy and teaching specific skills so that one treatment professional provides, or at least coordinates, therapy and case management activities.

The approaches are common in substance abuse treatment programs. A program for women who have substance abuse problems used the clinical case management approach due to the belief that women have special needs in the treatment setting. Case managers play a pivotal role for their clients, helping them receive the care and resources they need. It appears that especially descriptive, retrospective, and quasi-experimental studies have shown beneficial outcomes, while studies applying a methodologically stronger design randomized and controlled trials have often failed to prove the effectiveness of case management compared with other interventions, particularly over a longer period of time.

Although relatively few differences have been observed with control groups receiving standard or other viable treatment, significant improvements over time have been consistently reported concerning various client outcomes Thornquist et al. These observations stress the importance of deliberate implementation of case management programs and their integration in the existing network of services for adequate matching and referral Vanderplasschen et al.

Also assertive community treatment helped patients with dual disorders improve over a three-year period, but not any differently as compared to standard case management. On the other hand, some evidence is available that the latter intervention affects treatment retention and client outcomes among homeless individuals Conrad et al.

Outcomes from both studies show that for severely affected populations, case management efforts should be sustained over long enough periods. Given the significant drug-related problems and numerous barriers to treatment that HIV-infected individuals experience, it may not be surprising that the effects of intensive case management are limited to improving access to medical services and increasing retention in the program Rich et al.

However, no randomized and controlled study has yet shown its effectiveness compared with other interventions. Similarly, the implementation of intensive case management for multi-impaired chronic substance abusers in Europe has generated significant gains which need to be confirmed in large-scale experimental studies.

Some evidence is available for the effectiveness of strengths-based case management, as at least two studies showed significant effects on service utilization and legal and employment outcomes for persons seeking treatment Saleh et al.

Controversy exists as to whether these effects can be maintained over time Saleh et al. Intensive and generalist case management have not always been directed at specific groups of substance abusers. Studies of the latter consistently show an impact on treatment access, participation and retention, and relapse and rehospitalization Evenson et al.

These findings illustrate what may realistically be expected from the implementation of case management, if this intervention is robustly implemented and continued during a substantial period. On the other hand, brokerage case management seems to affect in particular initial treatment participation and linking to services and should thus be applied for this specific purpose, e.

Without a control condition, authors may have wrongly assigned a time effect to case management, while other factors such as motivation, retention, and client characteristics may have accounted for these positive outcomes. Both hypotheses have been rejected based on the observation that persons receiving less intensive services show far less improvement.

Generally, models of case management have been compared with control conditions that include standard treatment, another innovative intervention or another model of case management, thus reducing the chance of observing significant differential effects. Also, other sources of bias may have obscured the differential effectiveness of this intervention.

First, bias may occur due to lower attrition rates in the case management group Vaughn et al. Second, partial or incomplete implementation and low intensity of the intervention due to staffing problems, lack of training and inexperience of case managers, and staff turnover may account for limited or no effectiveness Orwin et al. Since McLellan and colleagues could only demonstrate the effectiveness of a case management program 26 months after initial implementation, they further stressed the importance of precontracting of services to ascertain their availability and accessibility.

Perhaps this should not be surprising, since this intervention was originally designed to provide ongoing and supportive care to clients and to link them with community resources and existing agencies Rapp et al. Despite numerous empirical studies that have evaluated case management, no comprehensive review has yet been published about the effectiveness of this intervention for substance abusers.

This review may contribute to present-day knowledge about the effectiveness of this intervention and to its further implementation, and can be the starting point for a meta-analysis. However, some shortcomings should be kept in mind concerning the methodology of this review.

First, this review was based on articles published in peer-reviewed journals, which may have caused a publication bias cf. Since we found various and inconsistent effects and several studies that reported insignificant effects, we assume that our review was not merely affected by such a bias.

It can also be that published articles only contain the strongest findings of a study, while other insignificant observations were not reported. Analysis of the original research reports and data could address this problem, but this information is usually difficult to access at the expense of its comprehensiveness and quality.

Second, this review started from four different models of case management that have been accepted by a consensus panel of American specialists SAMHSA If insufficient details were given about the actual intervention or no specialized model was mentioned, these interventions may have been incorrectly classified as generalist case management.

Indicators to measure program fidelity and robustness of different models of case management are needed, as well as an accurate description of the implemented intervention Godley et al. Finally, contextual differences affect the implementation—and consequently the evaluation—of case management to a large extent SAMHSA Any firm conclusions about the effectiveness of case management are premature and even unwarranted, given the relative scarcity of randomized and controlled studies, especially concerning some specific models of case management clinical, brokerage, and strengths-based.

Additional studies are needed, mainly outside the United States, that apply a strong methodology among a sufficiently large sample. Small samples have accounted for limited power and reduce the chance of detecting small or medium effects Orwin et al. Studies that have utilized case management over a to month period have demonstrated long-term positive effects and even cost-effectiveness Oliva et al.

However, some authors have shown that effects plateaued or even deteriorated after a while, particularly when the intervention was discontinued Sorensen et al. Given the chronic and relapsing nature of substance abuse problems, application of a longitudinal approach to case management is indicated.

It is necessary to know if its value declines over time and when, if ever, case management efforts should be reduced or terminated Clark et al. Evaluations of the effectiveness of case management should include multiple outcome measures and process variables. Not only socially acceptable changes e.

Up to now, little information has been available about the crucial features of this intervention: what specific aspects contribute to specific outcomes?

A team approach, monitoring, treatment planning, outreaching, and focusing on strengths and good relationships with case managers have been associated with positive outcomes among substance abusers Vanderplasschen et al. In-depth qualitative research with clients and case managers is required to further explore elements that contribute to the effectiveness of case management. The general nature of the elements identified in qualitative studies can then be tested in randomized and controlled trials.

Based on this review of published articles, the authors conclude that at least some evidence is available for the effectiveness of some models of case management. As in the field of mental health care, obvious positive effects include reduced use of inpatient services and increased utilization of outpatient and community-based services, prolonged treatment retention, improved quality of life, high client satisfaction, and stabilization or even improvement of the situations of—often problematic—substance abusers.

Various authors have found significant effects over time for several drug-related outcomes, but often these did not differ from outcomes among clients receiving less intensive or even minimal interventions. Longitudinal outcomes are still unclear, but at least some studies have shown long-term effects if the intervention was sustained. Several aspects of the effectiveness of this intervention need to be studied further. The extent of the effects was beyond the scope of this article, but should be included in a meta-analysis concerning the effectiveness of case management for substance abusers.

Although some studies have shown that this intervention works, it is still unclear what exactly makes this intervention work and how long its effects last. Given the increased acceptance of the idea that substance abuse is a chronic and relapsing disorder, the role of case management should be discussed from a chronic care perspective.

National Center for Biotechnology Information , U. J Psychoactive Drugs. Author manuscript; available in PMC Sep Wouter Vanderplasschen , Ph. Rapp , M. Find articles by Wouter Vanderplasschen.

Find articles by Judith Wolf. Richard C. Find articles by Richard C. Find articles by Eric Broekaert. Author information Copyright and License information Disclaimer. Dunantlaan 2, B Gent, Belgium. Copyright notice. See other articles in PMC that cite the published article. Abstract Case management has been implemented in substance abuse treatment to improve cost- effectiveness, but controversy exists about its potential to realize this objective.

Keywords: case management, effectiveness, review, substance abuse, treatment. Open in a separate window. Robust ICM associated with higher rates of psychosocial functioning, less alcohol and drug symptoms and lower cost of intensive services S. Substantial cost-savings and enhanced recovery and psychosocial functioning after 12 months NS.

Reduction of injecting and sexual risk behavior not different between groups NS. Generally very satisfied with the program. Significant reduction of problem severity after six months, but no longer after 12 and 18 months. High degree of satisfaction with treatment services. Longer length of stay associated with better outcomes NS. Positive outcomes were related to longer retention. Length of treatment related to self-report of weekly drug use S.

No difference in cost-effectiveness over three-year period when focusing on substance abuse and quality of life NS. Positive relation between length of time in treatment and outcomes S. SBCM: additional improvement concerning drug use and self-help group attendance after six months S. SBCM-clients stayed longer in after-care services S , which was related with better outcomes concerning post-treatment criminality and drug use at month follow-up S.

SBCM had no direct impact on drug use severity, but indirectly mediated by treatment retention. SBCM had significant impact on perceptions of family relations and parental attitudes after six months S , but not on perception of partner abuse Inside SBCM: significant impact on utilization of medical and substance abuse services after 12 months.

Telecommunication CM: better outcomes for clients with higher premorbid cognitive abilities S. Cretzmeyer et al. SBCM regarded as effective and valuable intervention by participants. GCM: better treatment outcomes, including reduced alcohol and drug use after 36 months NS. Deterioration related with physical and mental health problems. Outcomes mediated by amount of drug abuse prevention and education. Length of stay correlated with improved outcomes S. Reduction of homelessness, alcohol use and drug use S.

Increased linkage to primary care and outpatient services, reduced utilization of acute and ED services and reduction in hospital costs S. Intensive Case Management The effectiveness of intensive case management cf. Strengths-Based Case Management Although the application of strengths-based case management is limited to a few projects, some evidence of effectiveness is available based on two large NIDA-funded studies in Iowa and Ohio cf.

Brokerage Case Management Since only one study has evaluated the effectiveness of brokerage case management, little evidence exists that this intervention contributes to treatment participation and referral to ancillary services Scott et al. Clinical Case Management Little evidence is available about the effectiveness of clinical case management, but this intervention has been associated with an increase in the provision of services and significant improvements concerning alcohol and drug use, medical and psychiatric status, and employment functioning after six months McLellan et al.

What makes Case Management Effective or not? Limitations of the Review Despite numerous empirical studies that have evaluated case management, no comprehensive review has yet been published about the effectiveness of this intervention for substance abusers.

Recommendations for Further Research and Practice Any firm conclusions about the effectiveness of case management are premature and even unwarranted, given the relative scarcity of randomized and controlled studies, especially concerning some specific models of case management clinical, brokerage, and strengths-based.

Survey of case management practices in addictions programs. Alcoholism Treatment Quarterly. American Journal of Drug and Alcohol Abuse. Effective services for homeless substance abusers.

Journal of Addictive Diseases. The role of case management in substance abuse treatment services for women and their children. Journal of Psychoactive Drugs. Towards an integrated treatment system for substance abusers: Report on the second international symposium on substance abuse treatment and special target groups. Social Work. Case management and assertive community treatment in Europe. Psychiatric Services. Cost-effectiveness of assertive community treatment versus standard case management for persons with co-occurring severe mental illness and substance use disorders.

Health Services Research. Medical Care. Outcome of a controlled trial of the effectiveness of intensive case management for chronic public inebriates. Journal of Studies on Alcohol. Treatment of methamphetamine abuse: research findings and clinical directions. Journal of Substance Abuse Treatment. Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder:A clinical trial.

American Journal of Orthopsychiatry. Intensive case management of persons with chronic mental illness who abuse substances. Hospital and Community Psychiatry. Evaluation of substance use outcomes in demonstration projects for pregnant and postpartum women and their infants: Findings from a quasi-experiment.

Addictive Behaviors. Case management to enhance AIDS risk reduction for injection drug users and crack users: Theoretical and practical considerations. In: Ashery RS, editor. Preliminary outcomes from the assertive continuing care experiment for adolescents discharged from residential treatment. Case management for dually diagnosed individuals involved in the criminal justice system.

Contingency management in outpatient methadone treatment: A meta-analysis. Drug and Alcohol Dependence. Iowa case management: Innovative social casework.

Drug treatment careers: A conceptual framework and existing research findings. Evaluating the impact of case management dosage. Nursing Research. Appropriateness of assertive case management for drug-involved prison releasees. Journal of Case Management. Impact of robustness of program implementation on outcomes of clients in dual diagnosis programs. Evaluating changes in symptoms and functioning of dually diagnosed clients in specialized treatment. Cost-effectiveness of substance disorder interventions for people with severe mental illness.

Journal of Mental Health Administration. Clinical case management: Definition, principles, components. Thirty-six month outcome of prenatal cocaine exposure for term or near-term infants: Impact of early case management. Journal of Developmental and Behavioral Pediatrics. On the problems of randomized clinical trials as a means of advancing clinical practice.

Effects of case management on retention in prenatal substance abuse treatment. The impact of intensive case-managed intervention on substance-using pregnant and postpartum women. Community-based case management for active injecting drug users.

Advances in Medical Sociology. An intensive case management approach for paroled iv drug users. Journal of Drug Issues. Does clinical case management improve outpatient addiction treatment? Improving substance abuse treatment access and retention using a case management approach.

A follow-up study of homeless women. Journal of Social Distress and the Homeless. Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders.

Motivational interviewing: research, practice, and puzzles. The effects of clinical case management on hospital service use among ED frequent users. American Journal of Emergency Medicine. Evaluation Review. Early experiences with primary care. Toronto, Canada: Addiction Research Foundation; Predicting post-primary treatment services and drug use outcome: A multivariate analysis. Washington, D.

C: National Institute of Justice; Successful linkage of medical care and community services for HIV-positive offenders being released from prison. Journal of Urban Health. Analysis of three interventions for substance abuse treatment of severely mentally ill people.

Case Management Insider | | AHC Media: Continuing Medical Education Publishing

A further look into case management roles, functions, models, and case loads. We also will discuss the state-of-the-art staffing ratios needed to support the various models. The prospective payment system for Medicare patients initiated the need for hospital staff to begin to think differently about how they organize and deliver care. Because hospitals would now be paid one fee for the entire stay, managing length of stay and cost containment became new necessities for hospitals.

Gone were the indemnity reimbursement methods under which hospitals had operated. Under the old payment schemes, hospitals were paid equally for services rendered, usually with little questions asked.

With the advent of prospective payment and diagnosis related groups DRGs , the federal government had essentially put hospitals on a budget, paying them a flat fee for the hospital stay, also known as a case rate payment. Following Medicare's reimbursement changes, many states adopted similar case rate methodologies for their Medicaid programs.

Within a few years, as healthcare costs continued to rise, managed care organizations began to offer healthcare benefit packages to employers at lower premium costs than had been offered under the indemnity programs.

Although managed care had been around for decades, it wasn't until the later s that it began to become increasingly popular. Its popularity correlated directly with the rising costs of healthcare throughout the United States. It became clear that modifications to the existing delivery methods that preceded prospective payment were essential. With this began a significant shift in how hospitals viewed case management, and many hospitals began to develop some version of a case management model at that time.

There were no national standards for case management roles, functions, models, or staffing ratios yet. Each hospital attempted to take their existing structures and modify them in some way. Utilization review, performed by nurses, was separate from discharge planning, performed by social workers.

The two roles did not intersect and had little to do with each other. In fact, prior to the introduction of prospective payment and managed care, there was little need for an integrated approach to these functions.

Once the reimbursement structures changed, the delivery models also had to change. Partially integrating models and roles. At this point, some hospitals began to attempt to interface the roles of utilization review and discharge planning. These models began to integrate the previously disconnected roles of utilization management and coordination and facilitation of care with discharge planning.

These roles began to intersect with discharge planning, which was managed by social work in the early models. The need to relate patients' clinical issues to their level of care and their discharge plan, drove this change forward.

Care began to shift to the out-patient environment with an explosion in home care agencies, infusion companies, as well as the use of sub-acute and ambulatory surgery. Today, we see a variety of models that have been adapted to the specific needs of organizations.

However, there are some fundamentals to any model that should be used. Adaptations can be made to these fundamental core roles. The state-of-the-art in CM models. Today, we see two basic versions of case management models: the integrated dyad model and the collaborative triad model.

With each of these foundational models hospitals can add the additional roles that they require to meet their specific needs. The integrated model represents a fully integrated model in which all core functions of case management are under the responsibility of the nurse case manager.

It represents one of the state-of-the-art models in use today. In this model, all case management roles are performed by a single case manager. The model integrates all previously disconnected roles and functions. Case managers working in this type of structure manage the patients in one of two ways. Either all the patients have a case manager assigned to them, or some do, based on pre-determined selection criteria. Today, the state-of-the-art model is to have all patients assessed and followed by a nurse case manager.

Selecting only some patients for case management may result in patients falling through the cracks and ultimately not receiving the post-acute care services they may need. However, in this model, not all patients will need to be followed by a social worker. The patients that will be followed will depend on the hospital's high-risk criteria that they select to help identify those patients who would benefit from social work services.

These criteria should be prospectively determined and understood by the case management team, as well as the other disciplines such as physicians and nurses. If not well understood, this can result in unnecessary referrals being made to social work, and additional work placed on the social worker to screen these patients out. In the dyad model, the case manager is responsible for some additional roles and functions. These include the addition of discharge planning and variance management.

In the dyad model, the social worker may be responsible for some of the discharge planning functions, or may be solely responsible for psychosocial assessments and interventions, with discharge planning completely under the responsibilities of the nurse case manager. The decision to share the discharge planning functions is that of the hospital, and has to be carefully considered. Things to be considered would include the types of patients the hospital typically cares for.

If the hospital deals with highly psychosocially complex patients, then some consideration should be given to how the work is allotted to each discipline. The integrated model is designed to allow for the division of discharge planning functions based on the issues that the patient presents with. The collaborative or triad model adds a third key player to the core case management team. In this model, the clinical and business functions of case management are separate roles with three team partners actively working together.

The case manager is not responsible for the business functions which are defined as:. Utilization management: Obtaining authorizations, managing observation status, and denial management. The case manager is responsible for risk screening, assessment and planning, coordination of care, resource management, and outcomes management. In this model, the social worker performs very similar roles and functions as in the integrated model. These include screening of patients, assessment and planning, brief therapeutic interventions, care planning, and crisis intervention.

For high-risk cases, the social worker assists with discharge planning functions as needed. Since both models are considered state-of-the-art, each hospital must determine which model will best help them achieve their expected outcomes. Pros and cons of CM models. The decision to select one model over another will depend on many factors that must be taken into consideration.

Case manages in direct communication with third-party payers and vendors — they know the case. Bundles highly time-dependent functions [discharge planning and utilization management]. Can be frustrating for staff to manage. If not done well, can morph into a set of tasks rather than an integrated approach to the roles and functions. Creates some duplication. The utilization manager and case manager are reviewing the chart for similar or same information. Case Management Insider February 1, Reprints Share.

The history of case management models The prospective payment system for Medicare patients initiated the need for hospital staff to begin to think differently about how they organize and deliver care. The case manager is not responsible for the business functions which are defined as: Utilization management: Obtaining authorizations, managing observation status, and denial management.

Consolidates business functions of case management into one role- builds expertise. Reduced duplication, fragmentation and redundancy. Case managers not consumed with routine payer functions. Data collected once for multiple purposes.

Expanded focus on documentation review and improvement. Collaborative Model Integrated Model Collaborative Model Bundles highly time-dependent functions [discharge planning and utilization management]. Requires intensive communication between triad members. Works best if all disciplines report to the same administrator. Will not work if staffing is inadequate. Infrastructure will crumble. Report Abusive Comment.

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Case managment model

Case managment model