Care Management Programs
Through a unique design, members are placed in one of three levels and, depending on their level, are given a variety of support, tools and services that are designed to help them understand and manage their medical conditions. Some even have the option of working one-on-one with a trained nurse or social worker to help them improve their condition.
LEVEL 1: Complex Case Management
This level is for members with complex medical conditions, or those who have multiple conditions. These members, such as adults and children with diabetes, asthma, Chronic Obstructive Pulmonary Disease (COPD) and/or congestive heart failure are contacted by a care manager who will assess their health status, work with them to develop a self-management plan, and help them in getting the right care.
* Some other examples of complex medical conditions include: high-risk pregnancy, cancer, HIV/AIDs, cardiovascular disease, renal disease, serious pediatric conditions, and stroke, spinal cord or brain injuries that require rehabilitation. To learn more about the special programs that serve member with these conditions, contact Provider Relations 1-888-895-4998.
LEVEL 2: Monitored Case Management
Members who have less complicated conditions (such as less severe asthma or diabetes) but have a risk for developing other conditions or complications, may benefit from ongoing monitoring and help with staying healthy. Care managers will track these members’ health status and needs over time, encourage progress toward their health goals, and periodically give them health information about keeping a healthy lifestyle.
LEVEL 3: Lifestyle Management
There are some members with conditions that are more easily kept under control. These members will receive routine mailings of material about their condition. This material will keep these members’ self-management skills up-to-date.
Other services provided by the program include:
- Periodic mailings of health educational materials
- Communicating to the member and health care provider about medical and pharmacy claims
- Use of the TeleWatch Health Monitoring System which allows members and their health care providers to monitor health conditions by telephone
- Review of medications and discussion with our clinical pharmacists if needed
- Assistance with getting behavioral health services; this service can be reached by calling the toll-free number 1-888-309-4573
- Outreach to eligible members as they leave inpatient care, ensuring they get the correct follow-up care and needed medical equipment
- Help with discharge planning, care coordination, and member and family education when moving from a hospital to a lower level of care to home
JHHC encourages providers to take advantage of the three-tiered system of health management program and to refer members whom they think will benefit.
To refer a patient – or if you have any questions – please call 1-800-557-6916, or email firstname.lastname@example.org.
JHHC's health programs and services are voluntary and are provided at no cost to the member. Members identified with certain needs may be automatically enrolled but are under no obligation to participate.