Demand management and case management: a conservation strategy.

PURPOSE/
OBJECTIVES: This article reviews the history and development of managed competition, and explores the possibilities of a new demand management strategy in the context of nurse case management to offer less costly, higher quality care for a greater number of patients. PRIMARY PRACTICE SETTING(S): The article examines the history and principles of healthcare demand management, its implementation in the hospital and clinical practices of nurse case managers, and its impacts in reducing costs while maintaining care levels. FINDINGS AND
CONCLUSIONS: The article develops and analyzes the conflicts and common ground between demand management and case management. First, demand-side strategies can be effective in reducing costs while maintaining quality of nursing care; second, nurse case managers should employ patient education, self-care, and staffing solutions to manage demand. IMPLICATIONS: Nurse case managers must apply demand management principles carefully. Their goal is not to restrict care, but to maintain the highest levels of care possible within the limits of their practice's resources and staffing. Two critical themes emerge: (1) demand management is a potential alternative to market-driven managed competition and (2) nursing case management can affect an effective form of demand management. However, the long-term implications of these nursing case management strategies on healthcare staffing need further exploration.