ADVOCACY AND CASE MANAGEMENT Patient Advocates provides health care management services through a patient advocacy approach. This approach seeks to manage care through the development and support of employees’ medical consumer skills, patient freedom of choice, and early detection and management of serious or potentially serious illnesses. Employees contact a PA nurse when they require hospitalization or selected outpatient procedures. Our nurses work cooperatively with patients and their providers to establish an appropriate plan of care. The final decision regarding treatment remains with the patient.

• all initial calls
• advocacy sessions with patients for outpatient procedures and admissions that require an inpatient setting but are likely to follow an expected course of treatment
• review for second surgical opinions
• continued discharge planning

Individual Case Management is recommended when patients have chronic or severe health problems. Patients receive assistance in navigating the heath care system and accessing the best care in an appropriate time frame. Each patient is offered:

• Information and education about their diagnosis and available treatment options
• Emotional Support
• Understanding what will happen in certain treatment situations
• Preparation for returning home from a hospitalization or out patient procedure
• On-going follow-up and advocacy

Individual Case Management is provided at two levels based upon level of intensity:

Level I: Ambulatory care/case management cases will be triaged

• Triggered by diagnosis or greater than 4 day length of stay (IV antibiotics, joint replacement, major abdominal surgery, non cancer), diabetes, chest pain, back pain, etc.)
• On-site hospital patient advocacy sessions for all non-level II patients
• Follow-up calls post discharge to assess condition and compliance with the treatment plan
• Claim and treatment feedback interviews
• Education calls and materials

  Focus on:

• less intense but potentially serious cases
• earlier discharge planning
• increased home services
• early intervention/ identification of post discharge complications

Level II: Catastrophic/ Crisis Case Management triggered by diagnosis or condition

• focus on larger, more costly cases

Education information is provided to patients, most packets include several publications that provide easy to understand information regarding certain diseases and treatments. Because literacy levels vary significantly by patient, our library includes information to meet the needs of most every patient.

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