If you meet all of the following, this information is for you

• You or someone you care for has one or more long-term medical illnesses, such as congestive heart failure, cancer, diabetes, dementia, or tuberculosis (also called TB).
• You are considering case management (when a nurse or social worker helps manage your care needs or those of someone you care for). Case management may have been suggested to you by a doctor^* or insurance provider.
• You are age 18 or older. The information in this summary is from research on adults.

What will this summary cover?

This summary will cover:

• What case management is and for whom it might be helpful
• What researchers have found about case management for people with long-term medical illnesses

This summary can help you decide if case management may be right for you or someone you care for.

Where does the information come from?

Researchers funded by the Agency for Healthcare Research and Quality (AHRQ), a Federal Government research agency, reviewed 109 studies on case management for people with long-term medical illnesses published through August 2011. The report was reviewed by clinicians, researchers, experts, and the public. You can read the report at www.effectivehealthcare.ahrq.gov/case-management.cfm.

What is case management?

Case management is a service in which a nurse or social worker helps manage or coordinate care for someone with a long-term illness. Care for people with long-term illnesses can be complex and might involve several different doctors and treatments.

A case manager can serve as a bridge between patients or caregivers and their doctors, the health care system, and community resources. Case managers may meet with patients and caregivers in their homes, in the doctor’s office or clinic, or by phone.

A case manager can help both with medical tasks and in coordinating care.

Medical tasks can include helping patients:

• Better understand their illness and care plan
• Watch for changes in their illness
• Work with their doctor to make sure they get the right care
• Work with their doctor to adjust medicines
• Follow their doctor’s care instructions
  • For example, helping patients take their medicine, check their blood sugar or blood pressure, or follow a certain diet
• Learn how to manage their own illness

Coordinating care can include helping patients:

• Navigate the health care system and their health insurance plan
• Stay connected with all their doctors and other health care professionals
• Make appointments for doctor visits, medical tests, or treatment sessions
• Connect with helpful community resources
  • For example, support groups, groups that provide meals or transportation, and services to give caregivers a break

Who might case management help?

Case management could help people with complex care needs, such as people with:

• Many long-term illnesses
• Congestive heart failure
• Cancer
• Tuberculosis (TB)
• Diabetes
• Dementia (forgetfulness, confusion, and agitation caused by illnesses such as Alzheimer’s disease)

How do you get a case manager?

Some doctors assign a case manager to patients they think the added support may help. Health insurance providers often offer case management to patients with long-term medical illnesses. You may get a letter from your health insurance provider about case management.

Different health insurance providers may have different names for case management, such as “disease management,” “care coordination,” or “self-management support.” Some types of “home health care” may involve case management. You or your doctor can contact your health insurance provider to find out if case management is covered for you or someone you care for.

What have researchers found about case management for people with long-term medical illnesses?

Researchers found that case management seems to work best when case managers:

• Work closely with patients’ doctors and other health care professionals
• Work closely with patients and/or their caregivers over a long period of time
• Talk with patients and/or their caregivers face-to-face rather than only on the phone

What should I think about?

There are many things to consider when deciding if case management may be right for you or someone you care for.

You should think about:

• The possible benefits of case management
• Your ability to meet with a case manager
• How comfortable you are with having someone help manage your own care needs or those of someone you care for
• How comfortable you are with having someone come to your home to meet with you

What are the costs of case management?

Health insurance providers may cover the cost of case management for patients with long-term illnesses. Contact your health insurance provider for more information.

Ask your doctor

To answer some of these questions, you and your doctor may need to talk with your health insurance provider:

• Do you think case management could help me?
• Is a case manager available through your office or through my health insurance provider?
• Will you contact my health insurance provider, or should I contact them?
• How long will the case manager work with me?
• How often will the case manager meet with me?
• Where will I meet with the case manager—at my home, at the doctor’s office or clinic, or by phone?
• What specific tasks could a case manager help me with?
• Will the case manager work directly with you and my other doctors and health care professionals?
• Will the case manager come with me to any of my health appointments?
• Are there any reasons not to have a case manager?

Ask your health insurance provider

• Can I get a case manager for myself or for someone I care for?
• Is case management completely covered under my health insurance plan? Will I need to pay anything?
• How do I sign up for a case manager?