Case managers bridge health-care gap

By Poorvi Adavi
“I spent $1,000 when my father fell sick. The insurance covered only half of the expenditure,” says John (not his real name), a Qualcomm employee from San Diego. “The doctors conducted many tests and then realized that it was just a fever.”

John’s case is not unique. Unfortunately, most patients today are confused by the maze of health care clinics, hospitals and doctor’s offices. Patients often feel they need help to decide what health care facility or course of treatment is the right one. According to a study conducted at Columbia University by Sheena Iyengar, author of The Art of Choosing, when people are overwhelmed with options they scarcely understand, they often pick poorly.

In other words, we all could use a little help when it comes to health care. This is where a case manager steps in. Case managers identify the level of health care patients need and help determine the not so obvious cost factors.

“A case manager also determines medical necessity and constantly reviews the level of care being provided, and recommends changes when needed,” says Miriam Snitkin, a lecturer for UC San Diego Extension’s Case Management Certificate. “Case managers help patients determine if they need a particular kind of test, treatment or procedure and help maintain the emotional and financial sanity of patients.”

According to the most recent data from the PricewaterhouseCoopers Health Research Institute, more than $1.2 trillion is being spent on health care each year in the U.S. According to the report, processing inefficient claims is the second-biggest area of wasteful expenditure, costing as much as $210 billion. Most of these expenses can be largely avoided through efficient case management.

Case management is an upcoming career in the health care industry and case managers have increasingly started to play a pivotal role in today’s health care system. They have a number of functions, including explaining options, costs and alternatives.

“I have seen where the case worker can actually save a person’s life by getting the right help at the right time for a patient who might have died otherwise,” says Brenda Macevicz, a San Diego resident.

The need for case managers is obvious. Patients often say they wish they could talk to someone senior at the hospital. Many patients don’t realize why they are being charged a certain amount of money. In addition, health care laws change rapidly and for case managers to be effective, it is imperative for them to keep abreast with these changes.

“The case management certificate program at the UC San Diego Extension helps students understand the above stated roles of case management in a very practical manner”, says Snitkin. “This certificate program trains students to engage themselves in the process of providing quality health care information to patients and understand, analyze and look for the most cost-effective solutions. It is perfect for people in the nursing field looking for a career change.”

The case management program, which started in 1995, currently attracts about 60 students a year. This program can benefit people with nursing or health care backgrounds, as well as those interested in social work. A nursing or health care background, although not necessary, is recommended so that managers can understand the nuances of each case.

“A diverse group of students from all over California and Nevada have taken our courses,” adds Snitkin. “This makes the program more interesting and brings a lot of inquisitiveness into the class, making it a very rewarding experience for students as well the faculty.”

Poorvi Adavi is a certificate student at UC San Diego Extension in the Business Management Essentials Program. Originally from Bangalooru, India, Adavi was a reporter with the daily newspaper The Hindu.