In a world that seems to move faster every day, navigating healthcare can feel like a full-time job. Patients and caregivers may need to coordinate across multiple health systems, medical record platforms, providers, and specialists while also trying to follow through with recommendations from different sources. Care management teams can help make that process easier — but what exactly do care managers do, how can you access their services, and how can you get the most from working with them?
To paraphrase the Agency for Healthcare Research and Quality (AHRQ), care management is a set of activities designed to improve patient care, reduce unnecessary services, avoid duplication, and help patients and caregivers manage health conditions more effectively.
Oftentimes, care management teams consist of an interdisciplinary team of both clinical and nonclinical professionals, such as nurses, social workers, or care coordinators.
Fortunately, there are many ways to gain access to a care management team. The most common route is through your health insurance coverage, such as Medicare, Medicaid, a commercial health plan, or a long-term care insurance (LTCI) policy. Other avenues include primary care physician offices, hospital systems, and government programs.
Here are some ways to connect with these services:
Once you are assigned a care manager, make note of their name, profession (nurse, social worker, or care coordinator) and contact information. Schedule an in-office appointment, or a call if you are working with a phone-based team.
Your first contact will often involve a structured intake or assessment. During this process, the care manager may ask questions to better understand your current healthcare needs and goals. Come prepared to discuss your health, daily challenges, priorities, and questions.
Once your care plan has been established, review each part carefully and ask questions about anything you do not understand. Your plan should reflect your healthcare needs, preferences, and goals. Make sure you understand and agree with the next steps.
Provide relevant information about your medical conditions, health coverage, care team, power of attorney (POA) or HIPAA representative, medications, and any nonclinical barriers to care, such as transportation.
Transportation and other nonclinical barriers are examples of social determinants of health (SDOH). Sharing this information helps your care manager coordinate with appropriate clinical teams to identify supports and community resources that may address your needs.
Report significant changes in your health status, such as a recent emergency room visit or hospitalization, as soon as you can. This allows your care manager to help coordinate follow-up care and make sure you have what you need when you return home.
If you are experiencing a medical emergency, seek emergency assistance first, rather than waiting to reach your care manager.
Your care manager is an expert at navigating the healthcare system and finding appropriate resources, but your participation is also important. Follow through with the recommended next steps, whether that means contacting a provider to initiate services or asking your care manager whether they can do so on your behalf.
Jane is an active 78-year-old who enjoys gardening and spending time with her grandchildren. After experiencing heart palpitations, she scheduled an appointment with her primary care physician, who recommended that she see a cardiologist.
Jane contacted her care manager, who helped her find a cardiologist within her health plan’s network. The care manager also assisted Jane with scheduling an appointment at a convenient time.
About a week before the appointment, Jane contacted her care manager for help with arranging transportation — Jane's daughter, who normally drives her, had been called out of town and wouldn't be able to give her a ride. The care manager contacted Jane’s health plan, confirmed that transportation services were available, and arranged a ride to the appointment.
Two days before the appointment, the care manager checked in with Jane and reviewed the checklist provided by the doctor’s office. With this level of support and preparation from her care manager, Jane was able to complete her appointment and felt more confident in managing her health.
Care management works best as a partnership with you at the center. Your needs, preferences, and goals should guide the care plan, while your care manager helps coordinate services, identify resources, and navigate complex systems.
This is not a passive relationship — it requires communication, follow-through, and mutual commitment. By staying engaged and communicating openly, you can make the most of your care management team and receive support that reflects what a healthy, meaningful life looks like to you.
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