Case Management: Cancer Care

Prairie States’ Case Management Nurses have been tracking cancer care efforts for our customers’ health plans for over 30 years. When a member faces a cancer diagnosis, our skilled RNs intervene early and engage closely, with a definitive purpose: ensuring the highest level of member care for the best possible outcome – while ALWAYS keeping an eye on savings.

Other third-party administrators rely on outside care management programs. At Prairie States, our in-house team of Case Managers works side-by-side with our claims staff, in real-time, on the same claims system. Every claim comes to us, so we see the entire picture, and share it. This integration of services and data allows our nurses to provide seamless, detailed and more timely responses throughout the course of the treatment.

Early identification and member engagement make an enormous difference in cancer cases. In 2020, 93% of patients identified to participate in Case Management for Cancer Care were actively engaged in the program. Our RNs foster an environment of healthy communication, leading to better care, understanding, and management of the case beginning on day one.

With vast resources to optimize care and avoid unnecessary costs, our RNs:

• Collaborate with an extensive network of specialty cancer care providers
• Identify the best available providers including Centers of Excellence
• Negotiate agreements and contracts to maximize plan savings
• Help with medication adherence and symptom management
• Assist with avoidance of readmission and costly ER visits
• Ensure members get the right medications including specialty pharmacy and place of service
• Educate members to keep them informed about care options

From diagnosis and treatment through recovery and ongoing wellness checks, our Case Management team is always by the member’s side. By engaging early, guiding expertly, and advocating extensively on behalf of the member, Prairie States’ RNs are the pathfinders to better outcomes and plan savings.