Definition: Case management is defined as the assessment, planning, and care coordination of services to meet a patient’s individual health care needs. Case managers often advocate for patients’ safety and positive health outcomes through appropriate care coordination and communication.1 Meanwhile, care coordination refers to the organization and planning of patient care activities and sharing of information between two or more participants who are involved with the patient’s care in order to achieve better health outcomes and provide safer care.2 Both of these terms go hand in hand to ensure patients’ unique health care needs are met and to achieve better health outcomes. If a patient's care is well-coordinated, emergency department visits, hospital readmissions, medical errors, and health care costs can be decreased.3
How it relates to quality-based care: Accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) encourage providers to focus on the quality of patient care. Case management and care coordination emphasize that improving the quality of a patient’s care is a team effort and that the proper coordination of care across a continuum of services is crucial to such quality of care. Elements that are vital to the PCMH such as continuity of care and expanded access to care are accomplished through appropriate care coordination. The health care team (consisting of a case manager, pharmacist, social worker, physician, nurse, etc.) should all work together to create a proactive care plan for the patient as well as establish appropriate monitoring and follow up for smooth transitions of care.2 Care coordination also consists of providing patients with community resources and taking into account the patient’s individual goals. These processes strive to combat the disjointed nature of current health care systems and standardize the care that a patient may be receiving from multiple settings, especially when it comes to chronic conditions.2
Involved organizations/oversight: The Case Management Society of America (CMSA) offers standards of practice for care coordination and case management. CMSA highlights the importance of case management to achieve well-coordinated, high-quality health care. The standards of care promote communication and collaboration among patients, families, and the interdisciplinary health care team and include key components such as care coordination across settings, advocacy, resource utilization, and evaluation of outcomes.1,3 Additionally, the Agency for Healthcare Research and Quality (AHRQ) encourages health care systems to implement and measure coordinated care.4 Developing and implementing care coordination and case management strategies can help save money for any institution and improve the overall health outcomes of patients.
Resources:
1. Case Management Society of America. What is a case manager? Brentwood, TN: CMSA. Available at: www.cmsa.org/who-we-are/what-isa-case-manager/
2. Agency for Healthcare Research and Quality. Care Coordination. Rockville, MD: AHRQ. Available at: www.ahrq.gov/ncepcr/care/coordination.html
3. Case Management Society of America. Standards of Practice for Case Management. Brentwood, TN: CMSA. Available at: https://cmsa.org/about/standards-of-case-management-practice/
4. Agency for Healthcare Research and Quality. Care Coordination Quality Measure for Primary Care (CCQM-PC). Rockville, MD: AHRQ. Available at: www.ahrq.gov/ncepcr/care/coordination/quality/index.html
Contributing Author:
Hindu Rao, PharmD
Clinical Assistant Professor of Pharmacy Practice
Chapman University School of Pharmacy
Last reviewed 3/2/2026 by Sarah Aldrich Renner, PharmD, BCACP & Carter Comisford, PharmD