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Case management and the payor: where are we and where do we go from here?

Over the past 20 years, increasing numbers of states have sought to control the costs of their home care programs by establishing case management systems. These payor-directed case management systems duplicate the activities of the caregiver agency and have proven to be quite costly. It is generally assumed that case management will continue to be an essential component of public home care programs, including any future federal long-term care program. However, there is reason to believe that cost considerations and other factors will lead to a much-reduced payor case management role.