HealthPlus of Michigan Medical Case Management program is comprised of
licensed, registered nurses and social workers. The primary goals of the
HealthPlus Medical Case Management program are to:
case managers monitor the member’s progress, evaluate his/her health status and
update the case management plan as the member’s condition and/or circumstances
change. Medical case managers and social workers work together to
coordinate financial, social, psychosocial, transportation, and environmental
services for members, as needed.
Medical Case Management program has two components: Complex Case Management
(CCM) and Primary Case Management (PCM).
Complex Case Management
Case Management (CCM) is available to members who have had a major health event
or diagnosis that requires the extensive use of healthcare
resources. Members who qualify for CCM may encounter barriers to getting
needed care and need help navigating the healthcare system. These members
may also be receiving treatment from many doctors and providers, have problems
following treatment plans, and have competing psychosocial
concerns. Complex case managers coordinate member care with the help of
the member’s practitioners,family, friends and/or community agencies to ensure
that needed care is received.
Primary Case Management
who do not qualify for CCM may be eligible for Primary Case Management (PCM).
PCM focuses on cardiovascular disease, diabetes, asthma and chronic
obstructive pulmonary disease (COPD). Primary case managers are also
dedicated to helping members who have recently been discharged from the
hospital or have utilized the emergency rooms. The goal of Primary Case
Management is to promote self-management through education. They strive to help
to meet the day-to-day needs of a member living with a chronic condition
utilizing evidence-based guidelines.
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