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International Medical Case Management:
Assisting the Ship-owners and their Club
by Christina DeSimone
CEO, FutureCare, Inc. New York, NY

The International Shipping Industry is responsible for the transport of 90% of the world's trade and maintains an estimated 50,000 merchant ships manned by over one million seafarers. These vessels are loaded and unloaded in seaports around the world, each with tens of thousands of port and associated workers. However, this growing industry lacks the support of an organized healthcare delivery system. Medical care for seafarers varies dramatically in quality and availability between ports. Ship-owners and their insurance providers negotiate with a multitude of port brokers and agents to secure care from a "cottage industry" of local providers.

Managing quality of care and cost is currently unavailable to the ship-owner, except retrospectively. Without a specialized healthcare program built into the ship-owners' company policies, there is no viable way to manage and control the medical aspects of crew claims from the onset. Without this program, the crewmember receives care that may not be qualified or may be clearly substandard. With a structured healthcare program managed by the ship-owners' fleet operations, the illness or injury can be controlled from the onset.

This plan involves assigning an early point of contact for the Captains and fleet managers with trained Medical Case Managers and Physician Advisors for utilization.

Trained Medical Case Managers and Physician Advisors can form a rapport and an open line of communication with the attending physician and the crewmember. This method of communication helps reassure the crewmember that he or she is being well taken care of. The Nurse Case Manager also completes a precertification process on care and cost prior to admission and stays in touch with the treatment team throughout the crewmember's stay in the hospital.

Once Retrospective Case Management or contact with the hospital and crewmember after treatment has been initiated, leaves room for clinical mistakes, unnecessary testing, a lengthier hospital stay and delays in repatriation.

In order to control medical costs and promote proper care, it is recommended that the ship-owners take a more proactive approach. Incorporating a Care Management program into fleet operations allows the ship-owner to provide the earliest intervention. A trained medical advocate is appointed to direct care to a preferred facility. If that is not possible and the vessel is not in a port near a qualified hospital, the Case Manager immediately contacts the facility at hand and announces her presence on behalf of the ship-owners.

Rendering supportive counseling to the crewmember and his family from the start and monitoring the care of the crewmember has a positive effect on the Ship-owners' good standing with their crew and establishes that the ship owner cares.

The health and well-being of the seafarer is the focus of this healthcare program and most important aspect of Medical Case Management. In the process, the ship-owner will control costs while providing the best care possible for his crew.