Support when you need it
You need a health plan that is there for you when you are sick. If you have more than one chronic condition or a serious illness, HealthPlus’ medical case management program can help you when you need it most. Our medical case management program can help members who:
- are seriously ill
- have complex medical needs
- have serious injuries
- have problems following their treatment plan
- require a high level of care and services.
Our nurses and social workers work with you, your family and your doctors. Together, we can develop a care plan that will help you get healthier and stay healthier.
Our Goals
The goals of the medical case management program are to:
- help you get better and stay better
- help you to manage your disease(s) and conditions
- improve your use and knowledge of medications
- educate you and your family about how to stay healthy
- make sure you get the care you need, in the right place and at the right time
Three Key Parts of the Program
Our medical case management program has three parts: primary case management, complex case management and social service. All three are geared toward helping you stay healthy. They support you when you need it the most.
Primary Case Management (PCM)
PCM helps you with your chronic condition by teaching you about self-management and preventive care. Primary disease case managers can help you and coordinate your care if you suffer from a chronic disease related to:
- a cardiovascular condition
- diabetes
- asthma or chronic obstructive pulmonary disease (COPD).
PCM also helps with other conditions that require short-term case management services. Complex Case Management (CCM)
CCM can help you if you have multiple health care needs (e.g., if you are a diabetic with heart disease, eye problems and kidney failure). It’s easy for such patients to be overwhelmed by all the things that happen once you get so sick. This is often the case if you have:
- had a heart attack, been diagnosed with diabetes or another condition that make it necessary for you to use a lot of health care resources
- received treatment from many physicians and providers in different places
- difficulty following the doctor’s advice
Our complex case managers work with you, your family and your doctors and /or community agencies to make sure you get the services you need. Social Services Program
Social services are also available to our members. Medical case management social workers help with:
- end of life issues
- education about appropriate emergency room use
- activities of daily living n the need for durable medical equipment
- psychological and substance abuse screening
- home safety concerns
- conflicts between medical treatment and religious beliefs
- language interpretation problems
- domestic abuse screening
- benefits evaluation
- environmental needs
- caregiver support
Social workers will help you find community resources. They will also provide help with coordinating your care if you have special care needs.
Please contact us if you would like to know more about the HealthPlus medical case management program. You may call our Customer Service Department at 1-800-332-9161 or our Medical Case Management Department at (810) 230-2029.
