Excelling in Care Management

Empowering members to access the very best quality care

Accessing the very best care: for employees with chronic or severe health problems, that can feel nearly impossible. At Tufts Health Plan, we passionately believe that the journey to better health should be simpler than it is. That’s why we are so proud of our unique approach to Care Management—and how time and time again, employers have told us how valuable the program is in supporting employees with complicated health issues who could use a little extra help.

Our goal is to ensure our members are working their way through the health care system and accessing the very best quality care. -Dr. Claire Levesque, Chief Medical Officer, Tufts Health Plan

provider speaking with patient

“Our care management team engages nearly 90% of the members we reach with our clinical programs," reports Dr. Claire Levesque, the Chief Medical Officer at Tufts Health Plan.

Our highly-trained Care Management team guides employees towards care that is effective, efficient, and—above all—compassionate.

  • 100% of our care managers are registered nurses.
  • Care managers receive training in motivational interviewing, disease-specific training, and unique cultural aspects of care.

Our Care Management Programs include:

  • Priority Newborn Care
  • Healthy Birthday
  • Transition to Home Program
  • Condition Management
  • Priority Care Program

Proactive patient outreach that makes a (big) difference

Our Care Management team doesn’t wait for the phone to ring. We take a proactive approach, so we can start working with the employees who need us as soon as possible. This means poring over data like daily admission reports, tracking emergency room visits, and working closely with provider teams to identify members who may benefit from care management. Once we’ve identified those members, we follow up with phone calls and letters, and even set up regular recurring phone appointments, until we’re confident that the employee is receiving the care they need to best manage their health.

96% of patients enrolled in Tufts Health Plan Care Management are very or extremely satisfied with their experience.

 

A healthy dose of one-on-one coaching 

The connections that form between our members and their care managers are nothing short of unique. That’s because every member enlisted in care management is paired with an experienced registered nurse for one-on-one coaching and support. The member and care manager then work closely together to manage care according to the member’s schedule, needs, and comfort, guided by the care manager’s knowledge of the system and the best ways to coach members towards their health goals.

Our expertise includes:

  • Transplant
  • Oncology
  • Chronic Kidney Disease/ESRD
  • Cardiac
  • Diabetes
  • Geriatrics
  • Pediatrics
  • Obstetrics

What our members say about their care managers speaks volumes1

“My care manager single-handedly relieved all of my concerns and fears when I brought my NICU baby home. She was calm, kind, caring, and educated about my daughter's specific needs. She made me feel comfortable asking questions. A true angel! Thank you from the bottom of my heart!”

I cannot believe my insurance company cared enough to call me after my ER visit. -Care Management Enrollee

“My care manager was wonderful. She helped me a lot and gave me a lot of useful tools and advice. I will miss talking with her — she was always very understanding and comforting.”

“It is an extraordinary program and played a key role in my recovery.”

“We were in crisis mode upon coming home with lots of holes in our discharge plans. Our care manager was a godsend!”

This program was an unexpected treasure for me. When I was overwhelmed it was a relief to hear from my care manager. Her coaching kept me on track to getting—and staying—better. Her suggestions for how to handle my limitations and resources I could tap were invaluable. I am truly grateful to her. -Care Management Enrollee

“My care manager was so kind and caring. She gave me help during my chemo treatments and was very sympathetic during a difficult time.”

“Special thank you to my care manager for the professional advice and comfort following a serious cancer operation.”

Collaboration in the name of compassion

What unites Tufts Health Plan and our providers is a common goal: compassionate and effective care with no gaps and no overlaps. How we get there is collaboration.

Every day, we coordinate closely with Provider Care teams and Pharmacy Benefits Management teams to identify members who could use a little extra help, and keep those members on track. Visit our office and you’ll see that same collaborative spirit at work. Need an example? Our Care Management and Behavioral Health teams actually sit next to each other, so they can readily exchange ideas regarding how to best manage behavioral health challenges.

By working closely with providers and with each other, we can more effectively help members access the best quality care.

  1. Actual quotes by Care Management Enrollees. Personal information has been withheld for privacy.

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