Care Coordination

Last updated: Nov. 12, 2020

Our care coordination program is led by our qualified, full-time care coordinators. You are encouraged to collaborate with us to help ensure care coordination services are provided to members. This program uses a proactive approach to help members manage specific conditions and support them as they take responsibility for their health.

The program goals are to:

• Provide members with information to manage their condition and live a healthy lifestyle
• Improve the quality of care, quality of life and health outcomes of members
• Help individuals understand and actively participate in the management of their condition, adherence to treatment plans, including medications and self-monitoring
• Reduce unnecessary hospital admissions and ER visits
• Promote care coordination by collaborating with providers to improve member outcomes
• Prevent disease progression and illnesses related to poorly managed disease processes
• Support member empowerment and informed decision making
• Effectively manage their condition and comorbidities, including depression, cognitive deficits, physical limitations, health behaviors and psychosocial issues

Our program makes available population-based, condition-specific health education materials, websites, interactive mobile apps and newsletters that include recommended routine appointment frequency, necessary testing, monitoring and self-care. We send health education materials, based upon evidence-based guidelines or standards of care, directly to members that address topics that help members manage their condition. Our program provides personalized support to members in case management. The case manager collaborates with the member to identify educational opportunities, provides the appropriate health education and monitors the member’s progress toward management of the condition targeted by the care coordination program.

Programs are based upon the findings from our Health Education, Cultural and Linguistic Group Needs Assessment (GNA) and will identify the health education, cultural and linguistic needs.