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Care Management Programs
Population Health Initiative
At no cost to you, the Plan Care Management program offers you the tools and ongoing support you need to better understand and manage your health through the Care Management Population Health Initiative.
The Population Health Initiative was developed to give you individual support and services that are designed to help you understand and self-manage your medical conditions. Assistance through the initiative is offered on two levels, depending on your need.
Complex Care Management - High Intensity
Complex case management is provided for adults and children with diabetes and asthma, as well as all adults with chronic obstructive pulmonary disease (COPD) and cardiovascular disease. Once a member is identified with complex medical conditions or a special need, our highly qualified staff determines the specific services the member needs. A wide range of services are managed by our staff of nurses and social workers who are trained to help these members coordinate services, access available resources, and serve as member-health advocates.
Case management is also available for the following:
- High-risk pregnancy
- Children with conditions such as sickle-cell conditions, genetic conditions, complications from prematurity, obesity, neurological problems
- End-stage renal disease and members on dialysis
- Members with rehabilitation needs for spinal cord injury, traumatic brain injury, severe burns, trauma from motor vehicle accidents, and stroke
Monitored Care Management - Moderate Intensity
Members with less complicated asthma and diabetes conditions may benefit from ongoing monitoring and improvement of self-management skills.
Once a member is identified with asthma and/or diabetes and may have risk factors for developing other conditions or complications, our skilled staff of personal care managers monitor the member’s health status and ongoing needs over time. These personal care managers encourage progress towards health goals. They provide guidance and tools aimed at improving overall self-management of asthma and diabetes.
Care Managers / Member Advocates
Care managers work closely with members and all their health care providers to share information to achieve the best possible health for the member. Care managers help members to improve their health and quality of life by:
- Assessing each member’s physical, psychosocial, spiritual and financial needs
- Educating members on ways to manage their health
- Assisting with referrals to specialty providers
- Coordinating care with our outreach and health education department, home health and other health and community agencies
- Providing ongoing communication to check member’s progress and to review for continuing services
Other Population Health-based services include:
- Periodic mailings of educational materials focused on increasing self-management skills and preventing complications.
- Use of the TeleWatch Patient Monitoring System, which allows members to enter health status data from home, which can be checked by their care manager and physician
- Review of medications and discussion with our clinical pharmacy services if needed
- Assistance with obtaining behavioral health services
- Treatment Coaches. This service can be reached by calling the toll-free number (888) 309-4573
- Assistance to members moving from a hospital to a lower level of care and then home. Staff works with providers, members, and families on discharge planning, care coordination, and member and family education.
- Greens, Beans & Leans: A Complete Diet & Exercise Guidelines
How to Self Refer:
We encourage members to take advantage of the services and programs provided by Care Management. Our Care Management Population Health Initiative services and programs are voluntary and are provided at no-cost to the member. Members identified with certain needs may be automatically enrolled but are no obligation to participate in these programs. If you have questions about our Population Health Initiative of other Care Management services, or if you'd like to make a referral to a program, call (410)762-5206 or toll-free at (800) 557-6916. We are available Monday through Friday, 8:30 AM- 5:00 PM. Any voice mail messages received after normal business hours will be addressed the next business day.
*Please do not send any Protected Health Information (PHI) and personal medical information when using the E-mail link bellow. Please include contact information in case we need to reach you.
For more information on any of the case/disease management programs please call 1-800- 557-6916 or e-mail at firstname.lastname@example.org