Here are a few more examples of medical management services:

Transition of care: Case managers support members as they undergo transitions in health care settings such as rehabilitation services or hospital changes. Follow-up care and any post-discharge needs are also organized by these professionals, which takes the burden off members to plan by themselves.
Chronic disease management: Case managers work closely with members who have chronic health conditions. They provide education, coordinate appointments and help members adhere to treatment plans, promoting overall health and wellbeing. If depression or anxiety keep a member from taking their medications as we need to start at the root and not just lecture them on pill reminders, the cost of hospitalization, or the complications of their condition.
Behavioral health: Beyond possessing this unique expertise to provide advice for your physical health needs, case managers will often develop a trusted relationship with patients over the course of regular conversations and coaching. Mental and behavioral health conditions are a growing concern and can be exacerbated by the stress of a chronic physical health condition or new medical diagnosis. Case managers can provide emotional support or direct members to community resources they may not otherwise realize are available.
Health education and social barriers: Case managers engage in health education initiatives, offering guidance on preventive care, healthy lifestyle choices, and wellness programs available through the health plan. Case managers also know that health care requires a whole person approach and assess barriers to care such as financial, transportation, safety, or food and find creative ways to break down those barriers.
Assistance with authorizations: In cases where certain medical procedures or treatments require prior authorization, utilization review nurses guide members through the process to ensure that approvals are obtained. This ensures the safety and appropriateness of care.

It can be difficult to make health care decisions at times – should I have that surgery or take that medication? Motivational interviewing along with decision support and education can help members make the best choice for themselves as they are actively participating in their own treatment plan. An informed member will make choices that are intrinsically motivated, which means they are more likely to commit to the steps needed for recovery and wellness.

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Discover the advantages of a TPA with integrated medical management services

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