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Case Management and Disease Management

MedStar Family Choice cares about you and we want to be sure that you are getting the care that you need. We understand that some medical conditions make it hard for you to manage on your own. The nurses and social workers in our Case Management department are available to work with members who have certain medical conditions. We offer two types of Care Management services for our members. These are Complex Case Management and Disease Management. These services are provided by telephone.

Complex Case Management

Complex Case Management is a service available to our members who have complicated medical conditions and need help arranging the services they need. This service is provided by nurses, and social workers. Complex Case Managers work closely with doctors. They work with members by telephone to help with arranging doctor visits, medical equipment, therapy and other services. Complex case management is available for the following conditions:

  • Multiple chronic illnesses with high utilizations
  • Catastrophic conditions/special needs requiring coordination of care
  • Special needs populations listed under Medicaid regulations who are not already in a MFC Disease Management program.
  • COPD 

Disease Management

Disease Management is available to our members who need help managing chronic diseases. This service is provided by nurses and social workers who work closely with our members and their doctors. They contact members by telephone and help members to understand their disease and to get the testing and care they need. They work closely with members to help them learn how to manage their disease. Disease Management is available for members who need help with:

  • Adult Hypertension
  • Adult Respiratory
  • Diabetes
  • High-risk Pregnancy
  • HIV/AIDS
  • Cardiovascular Conditions in Adults

MedStar Family Choice members do not have to enroll in these services. You may be automatically enrolled if we see that you have certain diagnoses or medical needs. Membership in Complex Case Management or Disease Management is voluntary. If you would like to ask about one of these programs or if you are already in one of these programs and you would like to stop participating, please contact us at 855-210-6203. We are available Monday through Friday 8:00 a.m. - 5:30 p.m. Any voice messages received after hours will be addressed during the next business day.

Information current as of: 06/01/17