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Is there a Future for Case Management?

Given consolidation within the case management world with, for example, the Active Assistance Group continuing their acquisition of a portfolio of brands (and for the sake of clarity it is not suggested that all the companies set out below provide case management services):

Active Assistance (UK) Group Limited:

  • Active Assistance Care Services Limited

  • Active Assistance Limited

  • Brownbill Associates Limited

  • Care and Case Management Services Limited

  • Caring 4 U (UK) Limited

  • J S Parker Limited

  • 1st Care Nursing Limited

  • Neural Pathways (UK) Limited

  • Northern Case Management Limited

  • Rehab Without Walls Limited

  • Tania Brown Limited

  • Westcountry Case Management Limited

… it seems that a picture is developing of a larger business trying to strategically position itself in order to increase market share and commercially optimize it's position within the 'food' chain. Nothing wrong with that: it's business after all...
There are some really good case managers who are worth their weight in gold but, like any walk of life, there are some poor ones as well (see Loughlin vs Singh [2013] EWHC 1641 (QB)) and therefore notwithstanding what I am sure are the appropriate corporate structures it seems to me that the potential for split loyalties adds a level of concern to an already [for the patient] traumatic situation.

But is there another way?

Research published by the Virginia C Crawford Research Institute, Shepherd Center, Atlanta GA (which I happen to be visiting next month in conjunction with DWF's BIRG) suggests that there may not only be "another" way but a better way.

I have previously written about the potential for peer mentoring in two recent Articles and, encouragingly, it seems that momentum continues to build. In Effects of Peer Mentoring on Self-Efficacy and Hospital Readmission After Inpatient Rehabilitation of Individuals with Spinal Cord Injury: A Randomized Controlled Trial [Gassaway et al Archives of Physical Medicine and Rehabilitation 2017;98:1526-34] the authors set out to investigate the effect of intensive peer mentoring on patient reported outcomes of self-efficacy and unplanned hospital readmissions.

To be clear, we are not talking about employed case managers charged with building a group business, we are talking about a peer group of spinal injured persons matched with the study participants (N = 158) based on injury level, age, sex and interests.

Participants (spinal cord injury and disease) were approached within two weeks of hospital admission. Peers could not provide medical advice but they were encouraged to share personal experiences and participants joined an SCI Peers Facebook page. Monthly activities were arranged for both participants and carers and follow up interviews were undertaken at 3, 30, 90 and 180 days post discharge.

Anyone who has read my previous Articles on the subject will know that there is a growing body of research promoting the benefits of peer interactions in providing relevant, effective context for injured persons but this was the first randomized controlled trial to be undertaken.

Results of this study showed that the growth rate for self-efficacy in the first six months was significantly higher for the experimental group than the control group. Interestingly, however, there was no real statistical difference in the pure number of hospital re-admissions between groups. Where the difference came was in terms of the cumulative number of days re-admission (43% reduction at 180 days).

The authors speculated that the increased self-efficacy within the experimental group did not reduce the number or need for interventions but, instead, promoted an earlier identification of problems, more effective treatment and, therefore, reduced periods of hospitalization.

So bringing all this back to where we started it seems to me that there will always be a place for really good case managers but the corporate model may not be the optimum solution for injured persons. That solution lies in empowerment of the individual and the availability of peers with relevant experience: Chronic Disease Self-Management Program: 2-year health status and health care utilization outcomes [Lorig et al Med Care 2001; 39: 1217-23]… people learn more and try harder when they learn from people they perceive to be like themselves…

Clearly further research is required but let's try to always remain cognisant of the fact that the primary concern has to be the injured person's health and the best way to manage that may not fit happily with the current round of consolidation within the case management market.

Contact

For more information please contact Ian Slater, Partner on +44 (0)161 603 5066 or email ian.slater@dwf.law

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This information is intended as a general discussion surrounding the topics covered and is for guidance purposes only. It does not constitute legal advice and should not be regarded as a substitute for taking legal advice. DWF is not responsible for any activity undertaken based on this information.

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