Tufts Health Priority Care - Complex Care Management

The Tufts Health Priority Care program is designed for members with complex medical needs such as the following:

  • Cancer
  • Stroke
  • Organ transplant
  • Multiple sclerosis
  • Spinal cord injuries
  • Congenital illnesses
  • Rare diseases
  • Complex medical conditions discharged from a facility
  • Other serious conditions

The program is intended to support the care prescribed by the member’s doctor and includes the
following components:

  • Telephone support from the dedicated nurse care manager on a schedule complementary to the participant’s needs and availability
  • Personalized care plan based on identified goals, evidence-based assessment and the physician’s plan of care
  • Educational resources for informed decision making
  • Coaching to improve self-management and effective communication with health care providers
  • Efficient coordination of care across physicians, health care providers and services
  • Access and referral to community resources for financial and social support
  • Depression and behavioral health screening
  • Caregiver strain screening

The program is available at no cost to members, and participation is voluntary.

Network physicians can directly refer their Tufts Health Plan patients to the program by calling 888.766.9818 ext. 53532. A nurse care manager will contact the member to discuss his or her needs and interest in the program.

Members who wish to enroll may also self-refer to the program by calling 888.880.8699 ext. 53532. Predictive modeling algorithms based on medical and pharmacy claims and program criteria are also used to identify members.
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