Case Management seems to be one of those terms people use when they are trying to group several health care support efforts into just a couple of words. By definition, case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective outcomes.
The underlying premise of case management is based in the fact that when an individual reaches the optimum level of wellness and functional capability, everyone benefits: the individuals being served, their support systems, the health care delivery systems and the various reimbursement sources.
Case management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation. The case manager helps identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source.
At The DONNA Foundation, case management accessed through the DONNA CareLine simply translated looks like this–
Patient:
Caucasian, female, 50’s, Insured.
Concerns:
Diagnosed with Stage III Breast Cancer
Needs help with cost of living expenses
Needs assistance with accrued medical/hospital bills.
Resolution:
Achieved debt reduction and debt forgiveness for cost of living expenses.
Established and enrolled patient in hospital financial relief program.
Achieved transportation grant to assist with car payments and insurance, ensuring patients ability to and from doctor and treatment appointments.
Patient:
Blended race, female, 30’s, Insured.
Concerns:
Diagnosed with Stage IV Triple Negative Breast Cancer with metastasis to the brain.
Needs help with future cost of living expenses.
Denied prescribed care/treatment (a PET Scan), needed to secure assistance with future cost of living expenses.
Resolution:
Educated patient’s caregiver on prior-authorization requirements and worked with caregiver to secure proper authorization for the PET Scan.
Scheduled and confirmed a hearing with Social Security Administration for SSI.
Faciliated qualification for a $500 grant to assist with transportation expenses to and from treatment.
Subsquent follow-up confirmed the needed PET Scan and SSI benefits had been approved.
And like this…
Mya, Stage III, 33
With no risk factors in my family I was stunned when I heard the words breast cancer. The DONNA Foundation helped me with childcare for my daughter when I was receiving chemo. They even helped me cover many of the doctor bills that were piling up. I am forever grateful for their assistance.
Rosa, Stage I, 72
Thank you to The DONNA Foundation, you saved my life. I was going to lose my home because I didn’t have enough money for my rent and my medicines. The DONNA Foundation helped me be able to get my medicines for free.
Case mangement is how The DONNA Foundation continues to serve families in need providing $5 of debt relief and support for every $1 invested. Case management is personalized healthcare options, something everyone deserves.