Case management is a collaborative process which assesses, plans, implements, coordinates, monitors and evaluates the options and services to meet an individual’s complex health needs, using communication and available resources to promote quality, cost effective outcomes.
Criteria for eligibility includes:
- Neuromuscular condition with major impairment/deterioration
- Severe physical trauma in past 3 months, inpatient 6 or more days, transitions in level of care anticipated
- Stroke within past 3 months, major impairment
- Severe spinal cord injury within past month, major impairment
- Pediatric members with 2 or more inpatient stays in last 6 months, not connected to services
- Polypharmacy: 15 or more (Medicaid)/12 or more (Marketplace/Commercial) prescribed medications
- Top 10% of cost (medical and pharmacy) in past 6 months, predicted to remain high risk, with 3 or more ED visits in past 6 months and have a high likelihood to have ED visits in the next 12 months. Predicted risk and ED likelihood score thresholds are set separately for the Medicaid and Marketplace/Commercial populations using Cotiviti Medical Intelligence.
- Other complex care situations which result in extensive use of resources (i.e. multiple uncontrolled chronic illnesses or complex medical condition and complex social situation)
- Comprehensive assessments
- Integrated goal and care planning
- Care and resource coordination
- Education about condition or disease, including self-management
- Community linkage and resources
Make a Referral for Case Management
Please complete one of our Referral forms below and fax it to 414-266-1715 or call 414-266-3173.
Read a story about how the Depression program has helped one CCHP member.
Asthma, Depression and Diabetes Programs
Asthma, Depression and Diabetes programs within CCHP are designed to improve the health of individuals with specific chronic conditions and to reduce health care service use and costs associated with avoidable complications, such as emergency room visits and hospitalizations.
Members with Major Depression over the age of 18, members with Asthma between the ages of 5-17 and members with Type 2 Diabetes over the age of 18 are provided an introductory letter explaining the program, including how to opt out if desired, as well as newsletter communications and preventative care reminders throughout the year.
Healthy Mom, Healthy Baby
Our Healthy Mom, Healthy Baby program helps pregnant women get the support and services they need to have a healthy pregnancy and baby. A member may receive services in her home or over the phone from social workers or nurses who are specially trained in maternal/infant health. This program also offers high-risk pregnancy services and breastfeeding support by Certified Lactation Consultants.
For more information about the Healthy Mom, Healthy Baby program, call 877-227-1142, option 3.
We would be happy to come to your office to discuss our various programs and incentives for each Notification of Pregnancy form we receive. Please complete one of our Notification of Pregnancy forms below and fax it to 414-266-4726.