台灣在快速高齡化的進程中，與其他高齡化國家一樣，面臨著如何將在地老化落實於政策的重要議題。發展整合式、以人為中心的長照服務是世界的趨勢。社區照顧可以用比機構照顧還低的成本達到更好的成果但需要更多的照護協調，導致個案管理的興起。各地因應其不同的需求與服務資源，發展出不同的個管模式，臺灣尚未有針對長照政策2.0討論個管模式的研究出現。本研究欲了解長照政策2.0下社區整體照顧模式中，個管員的角色與功能，進一步探究個案管理模式是如何影響整合照護與過程，期完整的描述社區整體照顧模式中個案管理的運作現況，並與過去的理論、個管文獻對話，引起閱讀者在台灣建構社區整體照顧模式下對個案管理制度與個管員角色與功能的反思。
本研究設計以質性研究方法中的個案研究法，採用Reilly（2010）提出的三個關鍵面向：忠於個案管理的核心要素、個案量、個案管理的實踐作為研究架構。研究對象為2016年11月衛福部審查通過、正式啟動的社區整體照顧體系，以南部四縣市（嘉義、台南、高雄、屏東）衛生福利部社區整體照顧模式審核通過名單中，立意取樣兩個單位進行個案研究，做資料的比對與分析。資料來源包含官方統計資料與檔案、半結構式深度訪談個管員及單位之主管。
研究結果發現，個案管理模式藉由個管員的實務工作提供以個案為中心的服務，但是其實踐的角色與功能受到政策系統的影響，政策一方面沒有提供足夠的權責給個管單位，另一方面也沒有釐清個管實踐範圍、工作細則、個案量等的條件，因此削弱了個案管理以個案為中心的目標。
政策仍在發展、Ａ級單位與個管員摸索實務上可行的策略，個案管理模式需要公部門明定目標並釋出更多的權責、和民間單位與服務使用者進行充分溝通與討論，才能讓個案管理在服務傳遞上發揮其最大的整合效能。

This study aimed to shed light on care managers’ roles and clarify the function of care management in the integrated care model in the community from the perspectives of frontline care managers and service providers in southern Taiwan. This research employed the case study method on two community integrated care. Three issue, including caseload, case-management practice, fidelity to the core element of care management were explored to explore care management practice in the integrated care model in the community. The document content analysis was used such as policy, press release, care plan, aims, caseload and meeting minutes of the program documentation. Each community integrated care model facing different problems affect the care management practice. In general, most of the care managers had to work in large caseload. Their core tasks were needed assessment and implementation of care plan. The result showed that lack of authority and ability to control long-term care services on supply side could be problematic in practice. To find the perfect solution to care management model suitable for everywhere is difficult. In this study, we provided two case models to reflect the role and function of care managers and hope to enrich discussion of the care management model and provide evidence-based feedback to the policy making of future care management in integrated services in large.

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