Case Management

When a managed care plan’s member experiences an acute illness or injury, for example a stroke, traumatic brain injury (TBI) or spinal cord injury, two questions immediately arise: How can we render medically necessary rehabilitation through a qualified provider to ensure safety and restore function? And how can we control costs during what is often a long recovery process? While acute care is almost always the first stop for the patient, discharge to another level of care is usually necessary to ensure the patient’s well-being and continued progress at home. Of the many post-acute options— subacute, home health and outpatient rehabilitation— Rehab Without Walls® is the provider of choice for comprehensive home- and community-based rehabilitation with true neuro expertise. As an innovative neurorehabilitation option, Rehab Without Walls® offers a lower cost alternative to acute care without compromising treatment intensity or specific services required.

Outcomes are more functional and durable than typically seen in outpatient or long-term care settings. That’s because Rehab Without Walls® focuses on achieving functional goals in the settings that create the most durable outcomes—the patient’s home, workplace, community, school and recreational venues. We build a plan of care around the individual patient’s needs, strengths, goals and real life circumstances then deliver it through a team of highly trained neurorehabilitation professionals. And we do this all in partnership with the payer, ensuring mutual goals, ongoing communication and close attention to how resources are managed.

First and foremost, at Rehab Without Walls®, we recognize the complexity of managed care systems and the many things they have to manage internally. We work with managed care to improve outcomes and control costs. We work with them as partners within their parameters to achieve the best for their members.

Free Admission Screen

For each new referral, Rehab Without Walls® reviews medical records, consults with the referring entity and meets with the patient and family—often with a 24-hour turnaround. This way, Rehab Without Walls® not only can determine if the patient is appropriate for services but also can share in advance with the payer vital information for making decisions including patient’s current status, needs, expected treatment outcome and services required. Think of it as a detailed map or chart on what the patient really needs, including number of estimated hours per week for each service, an estimated length of stay and an “end goal” of what we expect to accomplish. This allows payer and provider to work collaboratively with a realistic understanding of the overall cost of care in light of available benefits and determine how to proceed with treatment.

Utilization of Plan Benefits

We understand that managed care plans, even within the same company, are not all the same. For one, some have more limited rehabilitation benefits than others. In rare situations, the rehab benefit may be too limited for a comprehensive program like Rehab Without Walls®. On the other hand, when working within benefit limitations, Rehab Without Walls® may be the best option because each benefit is “spent” or more appropriately “invested” on the best fit, i.e., specialized rehab that’s delivered in an environment most conducive to the patient’s recovery. In other words, patients and payers get the most for their “benefit buck.” In addition, because we work within a comprehensive, interdisciplinary model of care, we have greater flexibility to treat as needed, ensuring that patients receive the services most appropriate to time and circumstances, rather than care that is restricted to a “one size fits all” model.

Clinical Coordination

At Rehab Without Walls®, every patient has a clinical coordinator, a dedicated neurorehab professional who oversees the patient’s care. The clinical coordinator works in close collaboration with the managed care case manager, communicating verbally and through written reports to ensure the payers’ expectations are satisfied. With many of our complex brain injury cases, the clinical coordinator provides the hands-on case management the managed care company is otherwise not in a position to offer. Clinical coordinators know neurorehabilitation, know the patient and family and know the local community. They guide the team and the patient and meet with the physician, mining every available resource to facilitate recovery. Under their watchful, expert eyes, multiple treatments progress without costly gaps and overlaps. By carefully monitoring and budgeting, they tend to enhance the therapeutic value of each plan benefit utilized. In addition, because they are deeply entrenched in the communities they serve, clinical coordinators also can support the rehabilitation process by connecting patients with non-funded and non-reimbursed options in the community such as state-funded services, local support groups and community centers—all of which advance recovery at no additional cost to the payer. By the time patients reach the point of discharge, patients and families are informed and already accessing programs and services within the local community such as transportation, school and vocational rehabilitation. They end treatment confident they can keep on track for their continued progress toward real life, long-term goals.