If you need a greater level of support and coordination for your care, you may be eligible for integrated care management (ICM). With ICM, our medical, behavioral health (BH) and community health workers can work closely with you and each other to coordinate the care you need.
Our complex care management program is for members who have long-lasting medical conditions and behavioral health (BH) or substance use disorders.
Your complex care management team understands the problems that people with special health care needs have. We work with you to arrange for care, services and equipment; teach you about your condition(s); and design the best plan of care for your needs. We coordinate with your care team (doctors, nurses, nurse practitioners and care managers) to make sure you get the right care, in the right place, at the right time. We can visit you in your home or community or talk with you on the phone to ensure your needs are being met.
You may benefit from our complex care management if you are dealing with things, such as:
- Multiple health conditions that are hard to manage
- Intensive-care newborn needs
- Pediatric care needs
- Cancer
- HIV/AIDS
- Organ transplant(s)
- Severe disability or impairment
- Severe traumatic injury
- High-risk pregnancy
- Frequent hospital admissions or emergency department visits
Getting services
We may reach out to you based on medical and pharmacy claims data to see if you would like complex care management support. In addition, you can:
- Call us at 888-257-1985 (TTY: 711) and request complex care management support
- Ask your physician(s) to call 888-257-1985 (TTY: 711) and refer you to the program. A nurse care manager will then contact you to discuss your needs and interest in the program.
We offer you behavioral health intensive clinical management services to those who:
- Have severe behavioral health or substance use disorders
- Have three or more behavioral health inpatient hospital admissions during a 12-month period
- Have not accessed or cannot access community-based services
- Experience a catastrophic event
- Have a history of multiple hospitalizations
- Are newly diagnosed with a major mental illness
- Have a substance use disorder
- Have special needs or cultural issues that require multiple agencies to coordinate services
For more information about our behavioral health services, call us at 888-257-1985 (TTY: 711), Monday through Friday, from 8 a.m. to 5 p.m.
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 do things, such as:
- 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
- Get information about programs that help pay for utilities (electricity or heat)
- Access emergency housing
- Get community services in addition to the services we offer
- Find disability support groups
- Get transportation to medically necessary appointments (if you qualify)
- Access mental health and/or substance use services
- Make and keep appointments
- Get health information
- Find out what resources and benefits you can get
- Coordinate your care with your doctors
- Learn about alternatives and resources for continuing care, and how to obtain it when your benefits are exhausted
To learn more about all of these services, call us at 888-257-1985 (TTY: 711), Monday through Friday, from 8 a.m. to 5 p.m. We’re happy to help!