The 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
The medical case management program is designed to help members navigate through today's complex health care system when they need it most. The program supports members who are seriously ill and have complicated medical and/or behavioral health needs that require a high level of hospital care and services. Each member is assigned to an integrated care team (ICT) as indicated. Our ICTs collaborate with members, their families and their physicians to develop an individual care plan that will maximize member outcomes.
The ICT is composed of highly-skilled clinical staff. At a minimum, team members include
May also include
The Medical Case Management program has two components, Complex Case Management (CCM) and High Risk Case Management (HRCM).
Complex 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.
Members who do not qualify for CCM may be eligible for High Risk Case Management (HRCM). HRCM focuses on cardiovascular disease, diabetes, asthma and chronic obstructive pulmonary disease (COPD). High risk 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 high risk 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.
Social Services are available to members who are experiencing certain barriers to care. Social workers may work with other case managers and community resources to assist members in obtaining durable medical equipment, addressing home safety concerns, transportation needs, language interpretation problems and other issues.
We encourage members to take advantage of the free, voluntary services offered through the HealthPlus case management program and are committed to helping them get effective and efficient, high-quality health care. A member's primary physician can refer him or her to the program or a member can self-refer. For more information about the HealthPlus medical case management program or to make a member referral, please contact our Customer Service Department at 1-800-332-9161 or our Medical case Management Department at (810) 720-2776.