Case Management

Today's healthcare delivery system faces many challenges and complex issues. We all want to reduce the cost of patient care without sacrificing quality. Patients, physicians, insurance companies, employers, government and the community desire methods to determine value, quality, accountability and cost efficiency across multiple continuums of health care.

What is case management?

Case management is an important part of every patient's hospitalization. It is a process that ensures that care is appropriate, timely and cost effective, and that the patient is receiving the best possible care. Patients and direct caregivers are assisted through the healing process to discharge by a team of healthcare professionals using a coordinated, collaborative approach.

The case management team consists of a skilled registered nurse (case manager), a clinical social worker and a utilization review nurse. These healthcare workers emphasize a team approach for quality patient care. They work with doctors, bedside nurses, dietitians and therapists to facilitate a holistic approach in achieving optimal care for patients and their families.

Case management objectives:

  • To facilitate optimal care for patients from before hospitalization through discharge at MedStar St. Mary's Hospital
  • To enhance active communication between patients/family members and healthcare professionals
  • To facilitate positive patient outcomes
  • To act as a clinical resource for MedStar St. Mary's Hospital's healthcare professionals
  • To serve as a liaison between the patient and his/her health plan or insurance carrier
  • To gather data accurately and in a timely manner, and to promote its use in identifying opportunities for improving patient outcomes
  • To formulate solutions to problems using a proactive approach

What does your case management team do?

The Case management team serves as a resource to answer questions you may have about your plan of care. During hospitalization, the team will:

  • Work with you, your doctor, nurses and allied health professionals to identify your individual health needs and goals
  • Help you meet your goals
  • Monitor your plan of care
  • Help with any special needs you may have
  • Assist in planning to meet your home care needs
  • Communicate with your insurance company to ensure that your stay is meeting its criteria for payment
  • Advocate on your behalf to obtain the maximum insurance benefit you are entitled to
  • Communicate with you and with your family about any known information concerning reimbursement of care

Following your discharge from the hospital, your case manager:

  • Will serve as a resource to answer questions you may have about your ongoing healthcare needs
  • May contact you by phone to determine whether your health and functional abilities have improved