Consider this Scenario…

A patient is seen by her physician every month; she complains of weight loss and confusion. She is given referrals to specialists and told to follow up. Month after month; the same story.

The referrals sit in her purse because she can’t figure out how to navigate the phone tree at the specialists’ offices. The weight loss and confusion continue, month after month. She’s lost over 50 pounds in 5 months and she now cannot figure out how to work her cell phone, much less make the appointments. She’s embarrassed to tell anyone that she can’t do these “simple” things, so they go undone and her health continues to decline.

What this patient needs is a case manager and the broad network of support the CM RN/SW can access to help her navigate through all the phone calls, appointments and paperwork. The case manager meets with the patient and her family, assesses the situation and creates a plan to most effectively support this patient’s needs. In this case, the physician agrees that home health services are in order; home health RN, ST, OT, PT and MSW are activated and community services are accessed for meals and transportation, pending more definitive diagnostics. The case manager keeps the lines of communication flowing between patient and all care providers.

For Our Patients and Their Families: Anyone who has any form of health insurance can access a case manager by calling the number on the back of their insurance card and asking to be connected to a Case Manager. If you need help to find a Case Manager, please feel free to contact lilleylz@upmc.edu. She will be happy to connect you with resources to find a Case Manager.

For the Healthcare Team: Just as Case Managers provide guidance and support for their patients/clients, one organization is providing more support, resources, forums, and outlets for the case management community than any other, Case Management Society of America/CMSA. Pittsburgh Regional CMSA Chapter is the local professional organization, providing education, networking and support to the entire Case Management community.

More information is available at www.cmsapittsburgh.com.
Editor’s Note: This article was submitted by Lisa Lilley, RN, MSN, CCM. Lisa is President of Pittsburgh Regional CMSA Chapter. She can be reached at lilleylz@upmc.edu or 412-302-9634.