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Primary Care Case Management (PCCM) is a system of managed care used by state Medicaid agencies in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment.〔Joanne Rawlings Sekunda, Deborah Curtis, and Neva Kaye. “Emerging Practices in Medicaid Primary Care Case Management Programs.” Prepared by the National Academy for State Health Policy for the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, June 2001〕 In the mid-1980s, states began enrolling beneficiaries in their PCCM programs in an attempt to increase access and reduce inappropriate emergency room and other high cost care. Use increased steadily through the 1990s. == History == In 1981, the 97th session of Congress enacted the Omnibus Budget Reconciliation Act (OBRA) which allowed state Medicaid programs to implement risk-based managed care programs as well as PCCM, pending HCFA(now known as CMS) waiver approval. The state had to meet two requirements in order to be granted HCFA approval. *The case management restrictions must not "substantially impair access" to primary care services of "adequate quality where medically necessary;" and *The case management restrictions must be "cost effective."〔Deborah A. Freund, Medicaid Reform: Four Studies of Case Management (Washington, DC: American Enterprise Institute, 1984).〕 In their earliest forms, PCCM programs closely resembled traditional fee-for-service Medicaid than managed care. Some states developed PCCM as a first step towards risk-based managed care and considered their MCO contracts as the main managed care system. As PCCM programs matured, state goals have expanded to improving quality of care provided. States have used strategies similar to network management principles used by MCOs.〔Joanne Rawlings Sekunda, Deborah Curtis, and Neva Kaye. “Emerging Practices in Medicaid Primary Care Case Management Programs.” Prepared by the National Academy for State Health Policy for the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, June 2001〕 PCCM programs have evolved over the past two decades through the addition of a variety of care management and care coordination features. These include payment innovations; increased care management resources; improved performance monitoring and reporting; increased resources for management of serious and complex medical conditions; and a variety of “medical home” innovations, including performance-based reimbursement, better use of information technology, increased contact with patients, and efforts to provide additional resources for physician offices. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Primary care case management」の詳細全文を読む スポンサード リンク
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