Case Management Services

MedStar Family Choice-DC 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 experience and expertise of the Case Management staff of nurses and social workers work collaboratively to develop strategies for case management intervention, educational efforts, gaining access to specialized programs and care coordination with practitioners. We offer different levels of Care Management and services for our enrollees. They include Complex Care (for adults and pediatrics) Case Management, Condition Care, Transition Care and Resource Management. For enrollees who require assisting with understanding their discharge planning needs after discharge from the hospital, will receive care coordination through our Transition Care Program. Enrollees who do not meet criteria for any of the case management programs but continue to require assistance from a nurse or social worker will be managed through our Resource Management program. All Case Management Services are available face to face or by telephone.

Complex Case Management

Complex Case Management is a service available to our enrollees 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 and other health care providers. They work closely with enrollees and or their representative(s) to assist with arranging doctor visits, medical equipment, therapy and other services to help enrollees regain optimum health or improved functional capacity. Complex case management is available for the following conditions:

  • Transplants
  • Amyotrophic Lateral Sclerosis (ALS)
  • Multiple chronic illnesses with high utilizations (e.g. Diabetes, Asthma, COPD, etc.)
  • Hemophilia or Coagulation Disorders
  • Gaucher’s Disease
  • Guillain-Barre Syndrome
  • Liver Failure
  • Cystic Fibrosis
  • Respiratory Failure
  • Ventilator Dependency
  • Burns >20% of Total Body Surface Area or 2nd/3rd Degree
  • Spinal Cord Injuries
  • Paraplegia with Complications
  • Severe Cognitive Functional Impairment
  • Sickle Cell Disease
  • Malignant Neoplasms (a very expansive list of tumors)
  • Cerebrovascular Accident (Stroke)
  • Cerebrovascular Hemorrhage
  • Osteomyelitis
  • Sepsis
  • Special needs populations listed under Medicaid regulations 
  • Complex Care Pediatric

Condition Care Program

Disease Management is available to our enrollees who require additional assistance, health education, and care coordination in managing their chronic diseases. This service is provided by nurses and social workers who work closely with our enrollees, their primary care physicians (PCP) and other healthcare providers such as specialists, behavioral health and substance use practitioners, school-based health centers and community-based organizations (CBOs). The goal is to help promote self-management and prevent elevation into a higher risk level . The program is available for enrollees who need help with:

  • Adult Hypertension
  • Pediatric Asthma
  • Adult Respiratory
  • Diabetes
  • Special Needs Population to include:
    • Individuals with physical and/or developmental disabilities
    • Individuals who are pregnant and high-risk
    • Individuals identified as homeless
    • Individuals with HIV/AIDS

MedStar Family Choice-DC enrollees do not have to enroll in these services. You may be automatically enrolled if we see that you have certain diagnoses or medical needs. Enrollment in any of our Case Management Programs is voluntary. If you would like to ask about one of these programs, please contact us at 855-798-4244. We are available 24-hours each day.

 

This program is funded in part by the Government of the District of Columbia Department of Health Care Finance.
Information current as of: 09/17/20