A senior citizen coughing due to his chronic condition, signaling he might qualify for complex care management services

What Are Care Management Services?

If you or someone you love is living with a chronic illness, you understand the difficulties that arise in everyday life, as well as overall quality and enjoyment of life. Healthcare, even for people in perfect health, can be difficult to manage alone. Missing medications, running out to the pharmacy and waiting in line, having to find transportation to and from doctor’s appointments… All these things can make regular healthcare challenging for anyone. Even worse, mistakes or missteps, like medication intake errors and missing scheduled medical appointments, can lead to major health problems or worsen existing chronic conditions.

Care management services shift your care to a holistic and home-based approach as you navigate life with one or more chronic conditions. If you are someone who struggles with your healthcare maintenance, or even someone who recognizes that there is room for improvement, you may benefit from care management. 

What Exactly Is Care Management?

Care management helps individuals benefit from a wide variety of support and community services. It uses integrated programs to extend beyond your current clinical care. They include programs to support you as you navigate the many social impairments resulting from your chronic medical conditions.  

This type of care is holistic. Rather than focusing on the part of you that is ill in a purely clinical sense, care management aims to focus on the entire person. You are more than your illness and the needs you experience as a result of your illness are not all clinical.

Many health professionals already recognize the tremendous benefits of holistic home-based healthcare for people with chronic conditions. Insurance companies are following suit in recognizing the importance and increasing use of these programs. Medicare Advantage plans, for example, are changing all the time to address the needs of seniors. After all, seniors make-up nearly half of Medicare subscribers. 

A care management team working with people living with chronic conditions includes nurses, social workers, and even patient educators. Care team members work together to create a health plan that is individualized and tailored to you and your specific needs. 

The services of care management include 24/7 support, patient education, medication management, symptom management, and preventative testing to avoid unnecessary emergency and inpatient services.

Potential changes to Medicare Advantage benefits should allow for additional non-clinical services for people living with chronic conditions. Clinical services are essential, but so are services that aim to educate patients and integrate them more fully into their communities. For many people, loved ones, family members, and/or caregivers will be an integral part of their healthcare plan. 

What Should I Expect? 

Here are some of the services care management can provide for you or a loved one living with chronic conditions. 

  • Review your medications and make sure you are an expert on your own prescriptions
  • Connect you with community resources that may be able to assist you, including transportation services, home-delivered meals, and many other location-specific services
  • Help you set goals that are important to you and serve as your health coach to assist you in moving toward those goals
  • Work with your primary care physician and specialty doctors to coordinate your care
  • Make an appointment to visit you at home to review your health care plan 
  • Accompany you to health care visits out-of-home to support you

How Do I Know If I Qualify for Complex Care Management? 

Typically, complex care management is for people with one or more chronic conditions. Whether or not you have chronic conditions, you should ask your doctor if this option might be right for you and contact your insurance provider to find out if it is covered under your plan. Some examples of chronic conditions that would qualify individuals for complex care management include:

    • Alzheimer disease and dementia
    • Arthritis
    • Asthma
    • Cancer
    • COPD
    • Crohn disease
    • Cystic fibrosis
    • Diabetes
    • Epilepsy
    • Heart disease
    • HIV/AIDS
    • Mood disorders (bipolar, cyclothymic, and depression)
    • Multiple sclerosis
    • Parkinson disease

Holistic home health programs such as complex care management for people with chronic conditions can be life-changing. These programs are proven to reduce health care costs and improve patient clinical outcomes. Care management for people with chronic conditions is evolving in many ways, and holistic home health care is a major innovation. With complex care management, you can have not only your clinical needs addressed, but ALL of your needs. 

We are all complex and dynamic individuals, and those with chronic conditions even more so. An approach to care that works for the whole self is an approach that values human life. Complex care management programs reduce the need for emergency visits since patients are more in touch with their medical needs, have a better knowledge of their medications, and have overall support to maintain a healthy lifestyle. They are in contact with their senior primary care team and able to not only manage complications as they arise but to prevent problems with an active care routine. 

You are an important member of your own care team, and you deserve to have all the information you need. You also deserve to be surrounded by experts who empower you to manage your chronic illness while you continue to enjoy the highest quality of life possible. Contact Cano Health about care management today.