When a patient is undergoing treatment for an acute or chronic condition such as cancer, it often takes an effort to make sure that she or he gets the appropriate care. Many chronic conditions require treatment from multiple facilities and entities, and individuals would likely find the process to be overwhelming. That’s why managed care entities such as Paramount use case management for members with serious conditions who need a lot of resources. Our goal is to make sure that services are delivered accurately—and that our members get the most out of the resources that are available to them.
The case manager is an advocate for the member’s health and well-being. Case managers work closely with members to provide education on how to manage their conditions. Case managers may speak with the member in an acute care setting, after hospital discharge, in a home care environment, or in an ambulatory care setting. One of the aims of case management is to get the individual and caregiver involved in the decision-making process, so that they understand the many facets of the health care they need and they receive the necessary treatment.
The desired goals of our case management program are:
- Treatment of the member in the least restrictive setting and manner
- Improvement of self-management of disease and condition
- Increase in member satisfaction
- Return of the member to his or her maximum potential
- Support for the Primary Care Physician (PCP)
- Utilization of participating providers
- Reduction in the cost of care
- Reduction of unplanned hospital admissions and inappropriate emergency room usage.
- Education of member regarding disease process
Do you have questions about case management at Paramount? Please feel free to call the Utilization/Case Management Department at 419-887-2520 or 1-800-891-2520.