Case Management

APS Healthcare’s case management programs provide patient advocacy and promote quality of care while improving patient outcomes and maintaining cost effectiveness. APS case managers work to ensure a member receives the proper care when affected by a major medical condition. This approach is designed to minimize the effects of the member’s condition and facilitate physical and mental recovery.

APS’ multi-disciplinary team of clinicians use their expertise in medical-surgical nursing, pediatrics, rehabilitation, oncology, diabetes, substance abuse, geriatrics and psychiatry, to develop a collaborative approach to managing the comprehensive needs of each member. The company’s URAC-accredited case management programs focus on the whole member, as opposed to just the chronic or acute condition at hand. All of APS’ case management programs are focused on developing an active treatment plan and encouraging member compliance with that plan.

APS’ licensed case managers coordinate the appropriate healthcare services to ensure members receive cost-efficient, quality healthcare. Major focus areas of this work are patient advocacy, proactive discharge planning and negotiation of fee discounts. Case managers also provide access to healthcare information to help members better manage their conditions and their overall health and make informed decisions about their healthcare.

APS’ case management programs are designed to:

• Eliminate inappropriate inpatient admissions or reliance on institutional settings whenever possible
• Eliminate unnecessary procedures
• Promote the use of alternative levels of care
• Reduce length of stay and improve overall health outcomes
• Provide targeted interventions and support systems that are cost effective without sacrificing quality

APS’ case management process allows for a comprehensive assessment of the patient’s health needs in order to develop an appropriate plan of care. This is a collaborative process that involves the patient, the physician and/or other healthcare providers, the payer and community resources.

APS’ patient-centric case management model emphasizes recovery and resilience and reinforces a collaborative approach between members, families, providers and community-based supports. APS’ case managers also emphasize employment, social and other natural supports and methods of self-determination as appropriate.

In addition to identifying members through utilization management and provider/community referrals, APS also uses proprietary informatics tools to help identify members who could benefit from case management. These tools often identify at-risk members before they become acute, enabling APS clinicians to proactively intervene earlier than traditional approaches.