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Complex Case and Disease Management

MedStar Family Choice has a highly qualified staff of nurses and social workers to assist in caring for your patients. We provide two types of Care Management services. These are Complex Case Management and Disease Management. Our nurses and social workers are responsible for specific programs, based on their areas of expertise. These services are provided telephonically.

Complex Case Management

Complex Case Management is a service provided by nurses, and social workers. These professionals are available to coordinate healthcare services for MedStar Family Choice members who require extensive use of resources or who need assistance to coordinate complex care. Complex Case Managers work closely with you, the provider, to ensure that members receive appropriate and timely medical services. You will receive updates and test results that we receive on your patients. In addition, our staff may contact you to share clinical information or to verify that services were received. We do appreciate your prompt response to these requests. Eligibility for complex case management is based on diagnosis and medical services. Complex case management is available for members meeting the following criteria:

  • Transplants
  • Multiple chronic illnesses with high utilization
  • Catastrophic conditions/special needs requiring coordination of care
  • Special needs populations, who require assistance with coordination of care and are not covered in a MFC Disease Management program
  • COPD 

Our MFC Complex Case Management Program offers the following services to our members.

  • Support from our Case Managers and other staff to ensure that your patients receive the assistance they need to facilitate appropriate services
  • Educational materials, as appropriate to understand their conditions
  • Assistance to coordinate homecare services as needed for skilled care as well as any outstanding teaching needs
  • Information on community or MedStar events such as health fairs or support groups that may be pertinent to their condition

Members of MedStar Family Choice do not have to enroll; they are automatically enrolled when we identify them with one these conditions. Membership in our Case Management program is voluntary and members have the option to stop participating at any time. If you would like a copy of the information provided to members, please contact our Case Management Department and we will be happy to share those with you.

If you would like to refer a member to our Complex Case Management Program, please fax referral to 202-243-5496 or call our Case Management Department at 1-855-210-6203. We are available Monday through Friday 8:00 a.m. - 5:30 p.m. Any faxes or voice messages received after hours will be handled the next business day.

Disease Management

Disease Management is a service provided by our MFC nurses and social workers. This program focuses on members with specific chronic diseases. Disease Management was developed to assist your patients to better understand their disease, update them on new information about their disease and empower them with self-care strategies. The program is designed to reinforce your treatment plan for the patient. You will receive updates and any test results that we receive on your patients. We will also provide you with information, as appropriate, regarding member compliance with testing, medications and self-management. In addition, our staff may contact you to share clinical information or to verify that services were received. We do appreciate your prompt response to these requests.

The following Disease Management programs are available to our members:

  • Adults Hypertension
  • Pediatric Asthma
  • Adult Respiratory
  • Diabetes
  • High-risk Pregnancy
  • HIV/AIDS
  • Substance abuse and/or behavioral health needs 
  • Cardiovascular Conditions in Adults
  • Infants, toddlers, school-age children and adolescents with evidence of developmental and mental disability and delay

Our MFC Disease Management Programs offer the following services to our members:

  • Support from our nurses and social workers and other staff to ensure that our patients understand their conditions and how to manage them.
  • Educational and informational materials related to understanding and managing their conditions.
  • Information on wellness and self-management classes.
  • Support of home health to provide care and/or additional education in the members' homes, as needed.
  • Information on community events and MFC events such as health fairs and support groups that may be pertinent to their conditions.

Members of MedStar Family Choice do not have to enroll; they are automatically enrolled when we identify them with one these conditions. Membership in a Disease Management program is voluntary and members have the option to stop participating at any time. If you would like a copy of the information provided to members, please contact our Case Management Department and we will be happy to share those with you.

If you would like to refer a member to any of our Disease Management Programs, please fax referral to 202-243-5496 or call our Case Management Department at 1-855-210-6203. We are available Monday through Friday 8:00 a.m. - 5:30 p.m. Any faxes or voice messages received after hours will be handled the next business day.

Information current as of: 06/01/17