If a patient needs a service for which he or she is not covered, the case manager explores alternative sources of care. The case manager assesses and evaluates the costs and benefits of various care options. It may also be helpful for the case manager to know about issues that might affect the patient's recovery or integration back into the community, such as home support, physical and environmental barriers, occupation, educational level, access to resources and support, experience with health care, previous accidents, learning barriers or preferences, language barriers, goals and expectations, and any fears or frustrations. Reassessment occurs periodically as new information becomes available and as changes occur. Evaluation provides an opportunity for the case manager to determine whether the activities have produced the anticipated effect and if not, to explore why.
Evaluation can influence decisions about further plans and resource allocation.
Case managers evaluate the cost appropriateness of the frequency and duration of treatments according to the patient's circumstances and progress, and the actual outcome as compared to the expected outcome. A case manager who realizes that a patient is not making progress as expected must determine why and take steps to resolve the problem. Successful evaluation requires knowing what to look for and asking the right questions, as well as a willingness to correct or redirect actions according to what the evaluation reveals. Evaluation information can include clinical data, physical gain, functional improvement, patient satisfaction, and progress toward goals. Case managers need to be familiar with the normal, anticipated rate of progress to judge whether the service provided is of value.