What is Case Management?
It is a process, managed by your healthcare team, to help you and your family find medical solutions. The case manager is your team coach and advocate. Together, you develop a plan of care to promptly control your illness, injury, or situation, and navigate through the maze of medical care progressing toward your medical goal.
Generally, patients with complex problems and considerable medical expenses receive case management support. Problems may be one or a combination of medical, social, financial, or mental health.
Who is eligible?
TRICARE Prime patients
Participation is voluntary
Catastrophic illness or injury
Chronic or terminal illness including chronic pain conditions
Multiple medical problems
Requirement for extensive resources
Functional / Physical deterioration
Lack of family / Social support
Multiple Emergency Department visits / Provider visit
Why would I need Case Management?
The need for case management services is determined through a collaboration between you, your family or caregiver, your health care team, and your provider. This collaboration will include a comprehensive assessment of your health, psychosocial needs, and use of health care services and resources.
Case Management can help by
Coordinating your care
Assessing, planning, and facilitating services for you
Evaluating your options
Advocating on your behalf
You or your family member may need Case Management if you have
Instability with chronic health problems
A serious terminal illness
An increased need for different provider specialties.
A need for more support and education during a critical period
Who are Case Managers?
Case managers are usually nurses or social workers who can help you and your family figure out complex health care and support systems. They will work with you to coordinate the services and other community resources you need.
They can help
Provide advocacy, support, and education
Reduce burden and streamline appropriate utilization of care
Partner with members of your healthcare team to assist in coordination of your healthcare needs
Monitoring for progress and desired outcomes
How long will Case Management services last?
Services last until your Case Management goals are reached or until you and your case manager decide they are no longer necessary and/or helpful. Case management may be resumed at a later time if needed.
Is there a fee?
Case management is a TRICARE / Prime benefit. There is no additional charge and no billing to your insurance for this service.
Referral to Case Management
Electronic Referral: Ask your Primary Care Manager (PCM) to write a consultation to Case Management services.
Self-Referral: You can self-refer by calling (410) 293-1323/1319.
Visit: Naval Health Clinic Annapolis, Case Manager Offices, first floor. 695 Kinkaid Road, Annapolis, MD 21402.
Who will be my Case Manager?
You will work with a registered nurse.
Will my Primary Care Manager be informed of these plans and services?
Your PCM is part of the team that helps you make plans and decisions about your health goals. Based on these goals, your case manager develops a plan and continually updates it as you progress. The PCM and you have the final say about your care.
Along the way, we share with you
Your progression according to the case management plan
Our professional evaluation of family dynamics affecting response to treatment
Medical insurance coverage as it impacts identified medical needs
Be cared for with courtesy and respect
Be told about your health care problems
Be told how your problems are usually treated and share in the planning
Be told what you can expect from treatment
Agree to your treatment
Refuse any part of your treatment
Be counseled about what complications could occur if you refuse a treatment
Be discharged from the case management program at any time you wish
Treat the case manager with courtesy and respect
Ask questions about any part of the care you do not understand
Discuss with the case manager any changes in your condition or how you feel
Talk to the case manager about other health problems you have had in the past
Inform the case manager about all medications and remedies you are using
Follow through on shared goals
Let the case manager know if you are having problems following any instructions
Let the case manager know if you decide not to follow the plan of care