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Care Management Programs

Healthier YOU Programs

Healthier YOU is the name of our programs designed for members who have conditions that may require care coordination.

Our Healthier You programs are staffed by care coordinators — nurses, social workers, health advisors and outreach coordinators who are ready to assess and follow up on your patient’s healthcare needs. Each program is based on collaboration with you, as our member’s healthcare provider, to promote self-management.

Healthier YOU programs include:

Medicare:

Care Navigation Unit: Care coordination for all our Medicare Advantage members, including our dually enrolled (Special Plan) members.

Medicaid and CHIP:

Baby Partners: Health Partners Plans maternity program that assists moms-to-be, from prenatal to post-delivery. (This program is also available to Medicare participants.)

Complex case management: Services designed for adults and children with multiple comorbidities, including physical and behavioral healthcare needs.

Disease Management: Educational and care coordination services for members with specific disease conditions:

  • Asthma: For adults and children
  • COPD: For adults
  • Diabetes: For adults and children
  • Healthy Heart (heart disease): For adults
  • Fit Kids (weight management): For children up to age 21

Optum Care Plus: Provides in-home nurse practitioner assessments and case management services for chronically ill members with complex health care needs.

Specials Needs Unit: Serves as a link between members, physicians, agencies, community services and Health Partners Plans.

Why Care Coordination?

  • Individuals who are actively managed have a higher use of appropriate services and improved adherence to clinical practice guidelines for their specific disease condition.
  • Coordination helps reduce ER visits and hospitalizations.
  • Patients are more likely to follow through with their physician’s recommendations for plan of care if actively case managed.

Enrollment process

  • Members in any plan are automatically enrolled when identified by their utilization history.
  • All programs are voluntary and members can always call us to opt out.

 

You can refer a patient to any care management program by calling Specialized Clinical Programs at 215-845-4797. 

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