Today’s health care delivery system faces many challenges and complex issues. We all want to reduce the cost of patient care without sacrificing quality. Today, patients, physicians, insurance companies, employers, government and society 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, cost effective, and that the patient is achieving 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 Care 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 the doctors, the bedside nurses, dieticians, and therapists to facilitate a holistic approach in achieving optimal care for you, the patient, and for your family.

Case Management Objectives:

• To facilitate optimal care for patients from pre-hospital through discharge from 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 SMH health care 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 the hospitalization, the team will:

• Work with you, your doctor, nurses, and allied health professionals to identify your individual health needs and goals
• Help you to 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 their criteria for payment
• Advocate on your behalf towards obtaining the maximum insurance benefit to which you are entitled.
• 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 health care needs.
• May contact you by phone to determine whether your health and functional abilitites have improved.