Care Management
Care Management at Community Health Plan is a comprehensive method of client assessment, designed to identify client vulnerability, needs, and goals, that results in the development of an action plan to produce an outcome that is optimal for the client. The goal is to provide client advocacy, a system for coordinating client services, a systematic approach to evaluation of the effectiveness of the client’s health maintenance, and most importantly, to support the client-provider relationship.
Community Health Plan uses clinical practice guidelines for chronic diseases (including behavioral health conditions). Evidence-based, peer-reviewed guidelines from nationally recognized agencies are used. The guidelines are reviewed annually by Community Health Plan Medical Directors and by practitioners in the appropriate scopes of practice from the Community Health Network. For more information about guidelines, see Provider Guidelines. A paper copy of each guideline is available on request.
The care management process is monitored through the following processes:
- No financial incentives
- Referral management
- Preapproval (prior authorization)
- Pre-admission authorization
- Hospital inpatient notification
- Concurrent review
- Discharge planning coordination
- Emergency room care
- Pre-existing condition review
- Case management
- Member Review and Intervention Program
- Disease management
- Clinical care criteria
- Transition of care