← Well Fall 2021

The Power of Care Management

Helping members with chronic health conditions achieve their best possible health

What is Care Management?

The goal of care management is to help members achieve their best possible health and quality of life. Our care management programs connect members who have chronic or complex health conditions (like diabetes, cancer, heart disease, a high-risk pregnancy or a behavioral health issue) with a dedicated nurse care manager to help them better understand their condition and take ownership of their care.

At Tufts Health Plan, care management is an integral part of every plan we offer. Our care managers work hard every day to identify members who could use a little extra help. They then proactively reach out to those members to help keep them on track.

Our goal is to ensure that all of our members are accessing the very best quality care. -Dr. Claire Levesque, Chief Medical Officer, Commercial Division

Benefits of Care Management

Care management can help improve health outcomes and decrease the cost of care for everyone. The benefits of care management include: 

  • Reducing ER visits and hospital admissions
    By helping to make sure our members are keeping up with their recommended care and making healthy lifestyle choices, care managers can help members prevent complications. They also teach members and their caregivers how to recognize early warning signs of worsening disease, to help avert health crises before they happen. 
  • Reducing readmissions after hospitalization
    Follow-up care is critical after a hospital stay or procedure. This may include medical appointments, physical therapy, home care and medications. Our care managers reach out to members after their discharge from the hospital to make sure they’re engaged in their follow-up care. 

100% of our medical care managers are registered nurses

  • Ensuring that both medical and behavioral health needs are met
    People with chronic diseases have higher rates of behavioral health issues,1 while those with behavioral health issues are at greater risk of developing chronic diseases. At Tufts Health Plan, our medical care managers and behavioral health care managers work side by side—literally, in some cases—to help ensure our members’ full range of needs are being met.
  • Improving the quality of care received
    When they’re working with a care manager, members are more likely to keep their preventive and primary care appointments, and stay in close contact with their providers. As a result, providers can more carefully monitor their patients’ health and step in as needed, helping them achieve better health outcomes.

It all starts with a connection

Our care managers create one-on-one connections with members who could benefit from care management, rooted in trust, collaboration and compassion. The member and care manager work closely together, based on the member’s schedule, needs and comfort, guided by the care manager’s knowledge of the best ways to coach members towards their health goals. All of our care managers receive specialized training to provide guidance that’s custom-tailored to each member.

96% of patients enrolled in Tufts Health Plan care management programs are very or extremely satisfied with their experience 

Our approach to care management is unique in that it truly puts the member at the center. As Care Manager Marcella Poulin explains, “Our care management isn’t really based on what we want. It's based on what the member wants.”

Care Management Team Manager Sharon Soucy adds, “We're not giving medical advice, but we have that medical perspective so we can help members understand what things mean or what they’ve been told, be it medication or diet or anything else.”

Our robust care management program is an essential part of our commitment to improving the quality and affordability of health care for all of the members we serve—no matter what health challenges they may face. Read our success stories for examples of the Care Manager-member partnership in action.