The maze of service providers for ailing military members can be daunting, especially for families already under the stress of illness or injury. Patients at Naval Health Clinic Quantico often have medical needs that have to be treated at other facilities, as well as social, psychological and financial needs that should be addressed by organizations entirely outside the medical realm.

That’s where case managers come in. This week, the country puts the workers who coordinate patient care in the spotlight, with National Case Management Week, from Oct. 13 to 19. A table in the mainside clinic’s lobby will highlight case management all week, manned by one of NHCQ’s five case managers and representatives of the Quantico organizations they work with.

“Case management is the process of assessment, planning and advocacy to meet our beneficiaries’ health and psychosocial needs,” explained Hazel Edwards, the clinic’s lead case manager. The industry came into its own in the 1980s, as a way to control health care costs, Edwards said.

“In the civilian community, it’s all about finances,” she said, noting that in the military medical system, case management focuses more on cost containment, coordinating services and helping providers collaboratively access the best possible resource for deficits in care.

Edwards said Quantico case managers work closely with the Wounded Warrior Regiment, the Navy Safe Harbor Program, an array of Marine Corps Community Services organizations, medical care providers and others to make sure patients’ needs are met in a timely manner. They look for gaps in care and the resources to fill them.

For example, she said, if a patient is diagnosed with post-traumatic stress disorder or traumatic brain injury, and his wife doesn’t understand the diagnosis, a case manager could refer the couple to a Navy-Marine Corps Relief Society nurse who would visit their home and enroll them in educational base services. In the case of a patient who is also experiencing marital discord, Edwards could find them marriage counseling services. If a service member’s child needs medical care, case managers can coordinate appointments with primary and specialty care providers and ensure transportation to appointments. Service members who have a deployment history and a medical need relating to the deployment, can be referred to the Semper Fi Fund for financial assistance. “They’re really the masters of coordinating this huge hodgepodge of care that’s available to the patients,” said Dr. Francesca Cariello, the clinic’s chief of organizational performance improvement.

She said case managers also help to prevent re-hospitalization by making sure outpatient care is in place before patients are released from the hospital. Their knowledge of the system allows them to manage patient expectations as to what services can be provided and what Tricare will and will not reimburse.

Patients can be referred to case managers by their primary care providers, their commands, the Wounded Warrior Regiment or their families. They may refer themselves.

“A large majority of our cases are active duty service members with some form of combat-related injury or illness, either medical or psychological,” Edwards said, explaining that these are the patients who tend to need multiple services and have complicated care plans. Some of the diagnoses that often merit case management are PTSD, TBI, substance abuse, complex pediatric illness and other long-term chronic conditions. Patients enrolled in the Exceptional Family Member Program or placed on limited duty are also candidates for case management, and case managers help patients who are medically separating or retiring transition to Veterans Affairs.

They can save work and money by preventing redundancies in service and making sure care is received when the patient needs it.

“Anywhere along the continuum, if there’s a breakdown, you’re looking at a very long time to get the care you need,” Edwards said. “Without appropriate specialty care, beneficiaries typically have increased urgent care and emergency room visits.”

The fact that the Quantico clinic is a relatively small facility makes case management all the more important, because patients so often have to rely on regional military hospitals and local civilian hospitals for inpatient and specialty care.

The Navy Bureau of medicine and surgery sets a caseload of 30 patients per case manager, but Quantico’s five case managers handle anywhere from 120 to 250 between them, with the usual count around 200.

All case managers must first be registered nurses, and military case managers are also required to have spent at least two of the last three years in case management.

Edwards, for example, often relies on her years of experience as a critical care nurse with a cardiac specialty. In her 14 years of case management, she also worked at three other military hospitals before arriving at Quantico five years ago.

Writer: mdicicco@quanticosentryonline.com