Community Case Management

Thursday, January 28, 2016

Situation

Without supports and services, more than a thousand children and adults in Massachusetts could be forced to leave their families and live in institutions to get the care they need.

Challenges

Families needed help cutting through the red tape and obtaining the nurses, personal care attendants and medical services essential for complex care.

Solution

Nurse case managers work with MassHealth members to develop a care management plan based on individual needs that can be reassessed and altered as needed. We then connect members with any service they require for their health and well-being – such as physical therapy, medical equipment, medical specialists, and home/personal care support. We also coordinate the payment of services, and conduct third-party liability activities to identify insurers financially responsible for medically complex care. This supports care for members and reduces the overall cost of services for the state.

Results

Since the Community Case Management program began in 2003, we have assisted more than 1,600 MassHealth members and currently work with nearly 700 Massachusetts residents and their families. By keeping children and adults out of institutional care and identifying third-party payers, we are not only able to improve the quality of life for those served by the program, we are able to reduce overall medical costs for Massachusetts.