Disease & Complex Care Management
We offer free, comprehensive disease and case management programs for members.
Free service to members
Medical Associates Health Plans makes a continuous effort to improve the quality of services that we deliver. One of the ways we strive to accomplish this is through our case management programs, into which members are automatically enrolled free of charge.
We offer a comprehensive Disease Management (DM) program to benefit members with diabetes and hypertension. In addition, we provide Complex Case Management services for members who are faced with multiple and complicated medical conditions.
Both of these valuable programs are coordinated by highly skilled, compassionate registered nurses who personalize and tailor their services to benefit each individual person. Our nurses work in tandem with the physician to reinforce and strengthen the member’s understanding and management of their medical condition(s).
Promoting quality of life
Case management is an approach to healthcare that teaches people how to manage chronic illness so that complications are minimized and quality of life is promoted. A strong emphasis is placed on education, which plays a key role in reinforcing a member’s knowledge of their medications, diet, physical activity, warning symptoms, and emergency plan. The majority of communications are conducted via telephone. All efforts by the case management nurses are done in support of the treatment plan already established by the member’s physician.
How members are enrolled
As a courtesy, Medical Associates Health Plans automatically enrolls any member into the DM program aged 18-85 who has incurred a claim for services from the clinic, emergency room, or hospital that is related to diabetes or hypertension. There is no cost to participate.
Once a member is enrolled, a letter is generated to welcome them and to encourage their participation. A notification is sent to the member’s care provider as well. Members are given the choice to opt out of case management services if they so desire, however, those who participate may enjoy some or all of these complementary services:
- Supportive phone calls from our DM nurse to ensure that the member is receiving the most efficient treatment, and to help with coordination of care as needed
- Educational materials to help members manage and control symptoms
- Newsletters containing updates to the DM program, current medical information about diabetes and hypertension, and tips for healthy living
- Courtesy letters with reminders of important exams
- Blood glucose meters and training on testing blood glucose levels
- Blood pressure testing
Members wishing to opt out of the DM program can notify the Health Plan by dialing 563-584-4777 or 1-800-747-8900 ext 377.
Complex cases
Some members qualify for Complex Case Management, an additional complimentary service that we offer. Members aged 18-65 become eligible when they:
- Have diabetes and two or more other chronic medical conditions
- Have an A1C greater than 9 percent
- Have had one or more hospital admissions during the past year
Members may be referred to Complex Case Management by their physician, by our Disease Management nurse, our Patient Services HELP Nurse, hospital discharge reviewer/planner, other health care professionals, or by self-referral.
Once enrolled, our Complex Case Management nurse contacts the member to explain the program and offer services. If the member opts to participate, then an introductory profile is completed over the telephone with goals and objectives planned.
The introductory profile generally includes a discussion of:
- Health status
- Medical history
- Medications
- Activities of daily living
- Behavioral health status
- Social issues
- Cultural needs and language preferences
- Visual and hearing needs
- Caregiver resources
- Health plan benefits
- Community resources
- Advanced planning (end of life care)
The frequency of ongoing telephone contact is scheduled according to the member’s needs, with an emphasis placed upon education and resources to optimize the individual’s wellbeing.
The average length of time for the Complex Case Management program is six months to one year, but can sometimes extend to two years depending upon the needs of the individual member.
Notify Send-Resource Group: CCMHP
