UnitedHealthcare members may receive services from more than one health care professional or undergo transitions in health care settings. Care coordination among all health care professionals involved in a member’s care can help improve health outcomes and overall experience.
Point of Care Assist
One way to coordinate care for UnitedHealthcare members is by using Point of Care Assist®, which provides real-time member information — including prior authorization, clinical, pharmacy, lab and cost data — to existing electronic medical records (EMRs), making it easier for you to address member needs.
Controlled substance monitoring
This program helps identify members who may benefit from having their prescription pain management regimens reviewed and evaluated by their care provider. Through this program, providers receive a comprehensive member-specific report that includes:
The clinical issue of concern
Prescription utilization details
Providers are encouraged to contact identified members to discuss and re-evaluate their overall pain management regimens and coordinate appropriate treatment, if indicated.
Timely postpartum care and maternity case management
Timely postpartum care can help contribute to healthier outcomes for women after delivery. We use HEDIS® guidelines to measure postpartum visit compliance. The standard is a postpartum visit between 7 and 84 days after delivery. We also offer a maternity case management program to help support members with appropriate guidance, education and counseling.
End-stage renal disease program
This program is designed to help improve clinical outcomes for members with end-stage renal disease (ESRD). The program coordinates care among the member’s care providers to help manage comorbid conditions, as well as dialysis therapy. Goals include reducing inpatient hospitalizations, emergency room visits and mortality, while improving quality of life.
Diabetic eye exam
Regular eye exam screenings for members with diabetes may help detect diabetic retinal disease. We use HEDIS guidelines to measure retinal eye exam performance for members ages 18-75 who have type 1 or type 2 diabetes. Continuity and coordination of care may be monitored through communication between the member’s primary care physician (PCP) and the eye care professional performing the dilated retinal exam.
Coordination of care survey questions
We ask members and health care professionals to provide their feedback on coordination of care through regular surveys. These surveys give us valuable information about their experience so we can continue to improve our care coordination programs.
Transitions of care
Follow-up visits after a member is discharged from the hospital should be timely, especially for members with complex care and after-care needs who are at risk for relapse and rehospitalization. This includes members with behavioral health or substance use disorders.
Availability of these care coordination activities vary by health care plan. For more information, please visit UHCprovider.com/contactus.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).