History of Case Management

Case Management has been practiced since the early 1900s. Early providers of case management services were public health nurses and social workers who coordinated services through the public health sector. Following World War II, insurance companies began to employ them to assist with the coordination of care for soldiers returning who suffered complex injuries requiring multidisciplinary intervention.

Ida Maud Cannon (June 29, 1877- July 8,1960) was a pioneer in the hospital social service movement which began in the first decade of the 20th century.

In 1906 Ida jointly organized the nation’s first hospital-based social work program with Dr. Richard Cabot at the Massachusetts General Hospital (MGH).

The current evolution of formalized case management began with Medicaid and Medicare demonstration projects in the early 1970s. These programs usually employed a social worker to arrange for and coordinate services to clients in categorically defined groups (e.g., low income, mentally ill, frail elderly). In general, the purpose was to coordinate, facilitate and follow over time a client’s use of an array of health and social services. Following the ’70s, several types of case managers were documented, and included: brokers, primary therapists, interdisciplinary teams, comprehensive service centers, and HMO-based physicians, to name a few. 

The focus of case management varied with the nature of the organization providing case management services, the target population, and the discipline of the case manager. In social service settings, the focus was on access to services, and case management for the elderly emphasized use of community based services to prevent institutionalization and control costs.

As cost containment programs emerged in the healthcare industry, the dual priorities of case management became meeting the client’s needs and making good use of community resources. Following these successes, insurance carriers and treatment facilities increasingly began to employ nurses, social workers, occupational therapists, rehabilitation counselors, and others as case managers.

A distinction has been made between “internal” case managers working within a treatment facility or program and “external” or independent case managers overseeing the delivery of services over the entire continuum of the illness or injury. Most external case managers are RNs who either work directly for the payor or who are independent contractors providing case management services.

Today, case management is recognized as an essential component of managed care, which is the key to major healthcare reform in the U.S. Utilization of care management services has proven its worth in terms of improving rehabilitation, quality of life, increasing client satisfaction and compliance with a medical care regimen, promoting client self-determination, and reducing health care costs.

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