Dealing with hard-to-manage health conditions?

Our medical professionals, behavioral health (mental health and/or substance use) professionals and community health workers work closely with you and each other to coordinate the care you need. We provide three types of integrated care management services:

Complex behavioral health (BH) and/or medical care management

• Extra services to help you manage your ongoing conditions like:
  • Intensive-care newborn needs
  • Severe disability
  • Cancer
  • HIV/AIDS
  • Organ transplant
• Support with acute illnesses/catastrophic health events, such as motor vehicle accidents, stroke, etc.
• A greater level of support and services for your BH care available if you:
  • Have acute or severe persistent BH issues
  • Need help accessing community-based services
  • Are newly diagnosed with a major mental illness
  • Have had three or more BH inpatient hospital admissions over a period of 12 months 

You can call 888-257-1985 to get complex care medical management services, or your in-network physician can refer you to the program. Based on claims data, a Tufts Health Plan care manager may contact you to discuss your needs and interest in the program.

Community Health Services program

The Community Health Services program connects members with Community Health Workers (CHWs).  CHWs are certified public health workers who apply their unique understanding of the experience, language and/or culture of the populations they serve. CHWs spend a significant portion of time conducting outreach in the communities they live in and serve. 

Our community health program helps you with any situation that affects your health and well-being. We can meet with you in a convenient place and help you:

• Find a doctor
• ​Apply for food stamps
• Ask for benefits like Supplemental Security Income (SSI) and Social Security and Disability Insurance (SSDI)
• Coordinate services with the Department of Transitional Assistance (DTA) and/or the Social Security Administration (If eligible)
• Get information about programs that help pay for utilities (electricity or heat)
• Identify emergency housing
• Get community services in addition to the services we offer
• Identify disability support groups
• Coordinate transportation to medically necessary appointments (if you qualify)
• Access mental health and/or substance use services
• Help you make and keep appointments
• Customize health information for you
• Help you find out what resources and benefits you can get
• Coordinate your care with your doctors
• Help you learn about alternatives and resources for continuing care, and how to obtain it when your benefits are exhausted

Call us at 888-257-1985 (TTY: 711), Monday through Friday, from 8 a.m. to 5 p.m., to talk to a care manager.