Integrated Care Management

Care management is everything we do to help you get and stay healthy.

To make sure you get the best possible care, we use an integrated care management model. This model means that, when appropriate, our medical, behavioral health (mental health and/or substance use) and social care managers work closely with you and each other to coordinate the care you need.

We provide three types of integrated care management services:

Complex care medical management

Our complex care medical management program is for members who have long-lasting medical and behavioral health (mental health and/or substance use) conditions.

Your complex care medical 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 are able to 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 medical management if you are dealing with:
 

  • Multiple health conditions
  • Intensive-care newborn needs
  • Cancer
  • HIV/AIDS
  • Organ transplant(s)
  • Severe disability or impairment

Getting services

We may reach out to you based on medical and pharmacy claims data to see if you would like complex care medical management support. In addition, you can:

  • Call us at 888.257.1985 (TTY: 711) and request complex care medical management support.
  • Ask your physician(s) to call 888.257.1985 and refer you to the program. A nurse care manager will then contact you to discuss your needs and interest in the program.

For more information, call us at 888.257.1985 (TTY: 711), Monday through Friday, from 8 a.m. to 5 p.m. We’re happy to help.


Behavioral health intensive clinical management (ICM)

We offer you behavioral health intensive clinical management (ICM) services to those who:

  • Have severe behavioral health (mental health and/or substance use) issues
  • 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 special needs or cultural issues that require multiple agencies to coordinate services

For more information about our behavioral health ICM 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.


Social care management

Our social care management 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:

  • 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
  • Identify disability support groups
  • Coordinate transportation to medical appointments
  • Access mental health and/or substance use services 

To learn more, call us at 888.257.1985 (TTY: 711), Monday through Friday, from 8 a.m. to 5 p.m. We're happy to help.

If you have specific medical needs and conditions, such as a high-risk pregnancy, cancer, HIV/AIDS, a behavioral health problem or any other ongoing health condition, we can:

  • 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