Case Management
Our Case Management programs include a set of processes that integrate utilization management, discharge planning, disease state management, advocacy, and education and risk management. We believe in taking a proactive and collaborative approach to coordinating care to ensure members receive the right care, at the right time, in the right setting.
Our Case Management programs include:
- Complex case management services
- High-risk pregnancy case management services
- Child care coordination services
- High-risk family case management services
- Behavioral Health
Complex Case Management Program
Complex Case Management (CCM) is a collaborative process which assesses, plans, implements, coordinates, monitors and evaluates the options and services to meet an individual’s complex health needs. CCHP’s CCM program focuses on our highest risk members.
Criteria for eligibility include:
- Members with Cystic Fibrosis who have at least one emergency department visit or hospital admission in the past 6 months
- Members with Multiple Sclerosis and who are experiencing major impairment and deterioration
- Members with polypharmacy of 20 or more prescribed medications
- Members experiencing severe physical trauma within the past 3 months who have had an inpatient length of stay greater than 6 days and for whom transitions in levels of care are anticipated
- Members with Sickle Cell Disease who have had 2 or more hospital admissions in the past 12 months
- Members with a severe spinal cord injury within the past 3 months
- Members who have had a stroke within the past 3 months and who are experiencing major impairment
- Other complex care situations will be considered
Services include:
- Comprehensive assessments
- Integrated goal and care planning
- Care and resource coordination
- Education about condition or disease, including self-management
- Community linkage and resources
Disease Management Programs
Our Disease Management programs are intended to address some of the most chronic and prevalent conditions of members, considering general criteria, including:
- Prevalence of chronic disease states
- High utilization of prescription drug use
- Potential for wide variation in treatment approach
- Potential for lifestyle modification to improve outcomes
- Therapies with treatment options
- Diseases with high-risk of negative outcomes
We use an integrated system of intervention, measurement and refinement of health care delivery that is designed to optimize clinical and economic outcomes within specifically defined populations. The goal is to enhance and support members’ knowledge of their respective conditions in an attempt to improve overall health outcomes.
Our Disease Management programs include:
Healthy Mom, Healthy Baby
Our Healthy Mom, Healthy Baby program helps pregnant women get the support and services they need to have a healthy pregnancy and baby. A member may receive services in her home or over the phone from social workers or nurses who are specially trained in maternal/infant health. This program also offers high-risk pregnancy services and breastfeeding support by Certified Lactation Consultants.
For more information about the Healthy Mom, Healthy Baby program, call 877-227-1142, option 3.
We would be happy to come to your office to discuss our various programs and incentives for each Notification of Pregnancy form we receive. Please complete one of our Notification of Pregnancy forms below and fax it to 414-266-4726.