Case Management / Discharge Planning

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 quality cost effective outcomes. (CMSA, 2010).

Military Case Management operates per the DoD Medical Management Guide, January 2009.

Purpose of Case Management
The purpose of Case Management is to ensure appropriate access to quality care and to promote care that is safe, timely and cost-effective by maximizing the available resources. The Case Manager must also interject objectivity and information where it is lacking, advocate for the patient when necessary and work collaboratively with the patient, family and/or interdisciplinary team to develop and implement a plan of care that meets the patient’s individual needs.

Case Management Goals & Objectives
The primary goal of Case Management is to find the most appropriate medical services for providing optimal care and promoting the best possible outcomes for the patient. This may be accomplished by providing care along a continuum, decreasing fragmentation of care across many settings, enhancing the client’s quality of life and combining cost. Case Management promotes the provision of quality care in the least restrictive environment. The objectives of Case Management are to manage care and resources over financial, legal, ethical and geographical platforms to obtain planned clinical, quality, and cost outcomes.

Who can refer to Case Management?
ANYONE can refer…. Self, family, doctor, other ancillary providers can refer for services. ALL referrals will be reviewed by a member of our team to assess appropriate criteria.

Discharge Planning
The philosophy of Discharge Planning is that it is a collaborative effort between the Discharge Planner and the health care team which includes the physician, patient, family caregiver, ancillary services, and other involved parties to assist in transitioning the patient to the next level of care without compromising quality.

The discharge planning process incorporates a determination of the patient’s post-hospital care preferences, needs, the patient’s capacity for self care, an assessment of living conditions, the identification of health or social care resources to assure high-quality post-hospital care.

Contacts

Phone:
(757) 953-7500/7499  

Location:
Charette Health Care Center
Building 1 Room C208


Hours of Operation:
Monday through Friday
0700-1630
Discharge Planners on-call Weekends & Holidays via pager 988-9227

Availability of Services:
Case Management & Discharge Planning Services.

Appointments:
Referral Service

Links:
Case Management Society of America (CMSA)

Tricare Medical Management Guide 2009

Milliman Care Guidelines

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