Accessing healthcare in the US is a complex process even once the task of finding a healthcare provider and insurance is complete. When a person experiences a complex health issue or is diagnosed with a chronic illness, that illness touches every aspect of his or her life. It is then vitally important that the healthcare system acknowledge both these effects on the individual and how that person’s current life and history can affect treatment. This is especially critical for individuals on Medicaid who are often living with complex, chronic, and/or disabling conditions.
Multidisciplinary Healthcare Teams
Within managed care settings, patients are treated by a multidisciplinary team rather than simply a primary care doctor. This team generally includes the primary physician as well as nurses, specialists, and health educators. Social workers represent a critical part of this team, but also one that is not always present in medical settings.
Medical social workers are responsible for integrating care
with the patient’s personal life and support systems, arenas that do not fall under the expertise of doctors. This means assessing the impact of all social, financial, emotional, cognitive, environmental, financial, and other support needs of the patient, communicating these within the system and to external systems such as in home care, and establishing plans for continued care and well-being.
Social workers entered the healthcare arena
to increase access to healthcare services for the poor and in need. Managing a chronic or terminal condition becomes exponentially more difficult for patients with barriers
such as mental illness, substance dependence, housing instability, low socio-economic status, and inadequate access to healthcare.
Social Workers and Managed Care
The goal of managed care, when it started, was to “manage [the] cost, utilization and quality
” of healthcare. Managed care providers have differing means for establishing this sort of efficiency and as such the role of social workers varies
depending on how they can improve the cost efficiency of service provision. This can create an ethical dilemma
, however, for the social workers whose primary duties are do what is best for the client and not reduce costs for the provider.
In addition, confidentiality
in a managed care setting, where the client information is shared openly between different parts of the managed care group, can be a gray area for social workers. For institutions like hospitals, social workers’ roles have shifted primarily to transitional services to outpatient care. Some areas of healthcare do not utilize social workers at all anymore.
Yet, as managed care becomes ever more present within the US healthcare system, there is an ever greater potential role for social workers within managed care organizations.
At the core of both institutions is a commitment to assessment
and data-driven service provision. Efficiency means providing the right services at the right time and addressing potential barriers to care. Efficiency is preventive care and reducing preventable harm
. Social workers are responsible for assessing the whole person, not just their ailments. Doing so necessarily reduces unnecessary treatment, diagnostics, and utilization of acute care.
Moving forward, there must be a focus on the promotion of long-term person focused care rather than simply short-term cost saving. Managed care has the potential to be a vehicle for doing so but only be employing principles learned from social workers.