Case Management Services
Case Management Services are available through Community Health Alliance. Case management services can be purchased in conjunction with utilization review services or may be purchased separately on an as-needed basis. Use of UR services helps to identify when case management could be used to coordinate care for potential high-cost cases and to document outcome results and cost savings.
CHA has adopted the Case Management Society of America definition of case management:
"Case Management is a collaborative process which assesses, plans, implements, coordinates and evaluates options and services to meet an individual's health needs using communications and available resources to promote quality, cost-effective outcomes."
Case Management Services are performed at the request of the payer but can be recommended by the employer, payer or insurance adjuster. Experienced registered nurses perform the Case Management.
CHA's mission for Case Management is to provide a link to cost-effective health care and to promote a medical route to improved health status of CHA contracted members.
Optimal health outcomes will be sought through compassionate, high-quality health care services in the most appropriate setting.
Case Management Services
On-Site Case Management
- Catastrophic cases
- Patients with secondary diagnoses that complicate or extend the primary diagnosis
- Multiple providers of care
- Educational needs of patient or family
- Evaluation and assessment of home needs
Telephonic Case Management
- To obtain information on medical equipment needs
- Negotiate costs and coordinate treatment
- Short-term case management
- Assist with evaluation of DME needs and negotiations for purchases
- Repeat admissions
- Limited available resources
Anticipated Case Management Outcomes
- Quality care provided
- Decreased fragmented care
- Coordinated appropriate use of funds
- Increased interdisciplinary collaboration
- Decreased readmission rates
- Appropriate use of health care funds
- Increased satisfaction for all
Initial reports outlining the medical needs, goals and possible cost savings are provided after initial evaluation. Monthly status reports and phone updates are also provided to the payer.
A closure report with details of activity completed and cost savings is sent to document the file.
A case management file can be reopened at any time that further case management needs are identified.