Health Choice Pathway will assist in managing the care of members with chronic or disabling conditions that can benefit from care coordination and assistance. Health Choice Pathway providers shall assist and cooperate with Health Choice Pathway case management programs.
Health Choice Pathway case management programs will include the following key areas:
- Identifies individuals with complex or serious medical conditions.
- Establish and implement a Case Management plan that is appropriate to the members’ specific needs and medical condition(s).
- Assessment of the member’s physical, psychological, social environment, financial, and functional status as well as the family, community, and institutional support systems.
- Includes an adequate number of direct access visits to specialists.
- Ensures coordination among providers.
- Considers the beneficiary’s input.
The Health Choice Pathway Case Management program promotes quality and utilization management by:
- Defining and tracking quality and performance indicators.
- Implementing measures that contribute to improving quality of care and cost-effective management of targeted conditions.
- Encouraging preventive care strategies to keep members healthy.
- Promoting member education and behavioral modifications that improve health outcomes.
- Educating members on available community resources.
- Monitoring outcomes and program effectiveness.
Providers may enroll members into the Health Choice Pathway Case Management program by filling out a Case Management Referral Form and attaching any pertinent medical documentation and faxing it to: (480) 317-3358.
Complex/High-Risk Case Management
Complex Case Management enrolls special needs members who are identified as high risk for hospitalization or needing assistance coordinating their medical and behavioral health needs. This will include members with chronic conditions, especially the aged, blind, and disabled, and members who have multiple co-morbidities. The Complex Case Management Program employs nurses that will provide intensive, individualized, one-on-one care plan management, and intervention.Case Management Referral Form