What is Case Management?

Every parent’s worst nightmare is a seriously sick child or one who has a lifelong or life-threatening illness.  Not only is there worry over the immediate prognosis and recovery, but also about how to care for the child once he or she returns home from a hospital stay. What can the parents expect when they have to care for their child on their own at home? How are medications administered?    What resources are available to help and which services and/or equipment are best? How can they get the best care and make their insurance coverage last?

These, and many more questions, can be answered by utilizing case management.

So what, exactly, is case management?  The Case Management Society of America defines it as:

“A collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes”.

Originally, case management grew out of post-war social services put in place to help injured veterans get settled back at home.  From there it began to encompass workmen’s comp cases where nurses or social workers were enlisted to help workers get the best possible care until they could get back to work.  In the late 80’s, case management entered the medical field to assist insurance companies and patients alike in overseeing medical care before and after being discharged from the hospital.

Today case management services (in some circles it is called care management) can be provided at the hospital, by managed care organizations, and by private case management specialists/companies, such as Primary Pediatric Management, Inc.

The services of a private case management specialist or company are generally enlisted by the insurance companies to help members covered by their plans get the best care and outcomes possible for the coverage they have.

The greatest benefit of a company like Primary Pediatric Management is the ability to give focused, individualized attention because of its smaller case loads. On-site visits are another important care option that is not readily provided by case managers with heavier case loads. Ideally, a case manager can help achieve maximum client wellness by identifying appropriate providers and facilities, identifying resources and facilitating access, and…of utmost importance…creating autonomy for the parents through teaching them how to be self-advocates throughout the treatment process and beyond.

If you have a child or loved one who will require ongoing medical treatment at home after a hospital stay or who has been diagnosed with a chronic illness needing specialized care, find out if you qualify for the help of a case management specialist and learn how it can be of benefit to you.

Contact Primary Pediatric Management, Inc. at 314.963.1307 or toll free at 877.734.PEDS (7337) for more information and a free 15-minute consultation with our case management specialists.