Case Management Case Study

A DAKOTACARE member was diagnosed with terminal metastatic lung cancer. She had used all of the skilled care benefits and was a perfect candidate for hospice. However, in her rural area of South Dakota hospice was not available. Hospice for the care she needed was only available in a larger city, which was over three hours from her home

Hospice nurses could not drive the three hours to her home and knowing that a three-hour drive would have put much strain on family and friends of the member, a case manager for DAKOTACARE looked for better options. The case manager visited with the account manager and local hospital then negotiated a one-time hospice stay at the local facility

The DAKOTACARE staff worked different angles and did everything in their power to provide a better option for the family, which allowed the member to fully utilize the benefits available to her

It was a difficult time for the member’s family and friends but they were very appreciative of the special arrangements and extra effort made by DAKOTACARE.

Case Management Case Study

A 50-year-old DAKOTACARE member had to have surgery for peripheral vascular disease. Post-operatively, he developed acute respiratory distress with respiratory failure. He had to be placed on a ventilator and sedated. Unfortunately, the hospital where he had the surgery had difficulty weaning him off the ventilator and they requested he be transported to another hospital. The referred hospital was a non-participating DAKOTACARE facility and the costs to admit were around $5,600 per day

Because of the extraordinary costs of the non-participating hospital, DAKOTACARE’s case manager went to work negotiating the best price for the family. DAKOTACARE was able to negotiate a cost savings of $4,200 per day and because the member could be admitted to the most appropriate hospital for his condition, fewer days were spent in the hospital

Ultimately the member was able to recuperate more quickly, went home sooner and saved tens of thousands of dollars to receive the level of care he most needed…all because of the extra effort and negotiating skills of DAKOTACARE staff