Care Management is provided to patients who have experienced an event or diagnosis requiring the extensive use of resources and who need help navigating the system to facilitate appropriate delivery of care and services. It is a collaborative process of assessment, planning, facilitation, care coordination, and evaluation, as well as advocacy for options and services to meet the comprehensive medical, behavioral health, psychological, psychosocial, and spiritual needs of a patient and the patient’s family, while promoting quality and cost-effective outcomes.
Condition Management is provided for all eligible health plan members who are identified with diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), asthma, hypertension and hyperlipidemia. The goal of the program is to support the practitioner/patient relationship and plan of care. The program emphasizes prevention of exacerbations, and complications utilizing evidence-based practice guidelines and works collaboratively to identify opportunities for prevention or intervention in an effort to provide well-coordinated care.