An overview
ConnectiCare takes a Total Population Health (TPH) Management approach to the overall care management of its members by providing broad access to coordinated health care services that improve health outcomes while reducing health care costs. ConnectiCare’s TPH Model of Care provides a personal health care manager, a partnership with the member’s doctor, locally based teams of multi-disciplinary staff, help in understanding and managing member’s medications, support during and after hospitalization, and a connection to community resources.
Members enrolled in active care management benefit from a personalized care plan developed and supported through one-on-one interactions with a registered nurse or social worker who oversees the care plan and coordinates with the rest of the TPH care management team. This team - which includes registered nurses, social workers, community health educators, field care managers, behavioral health clinicians, pharmacists, and medical directors - work together to ensure there is integration and connection of medical and community services.
Care Transitions Program
The ConnectiCare Care Transitions Program recognizes the known potential risks associated with transitioning from one practice setting to another. ConnectiCare’s program focuses on transition from acute and subacute facility to home with the goal to prevent acute readmission.
Risk stratification
ConnectiCare's risk stratification process ranks members according to a risk score that is determined from a review of medical claims over a rolling 12-month look-back. A prospective risk score, internal utilization-based risk score, and a co-morbidity score are combined to produce a total risk score and overall ranking. Risk scores are mapped to a high, moderate or low risk group. Members who are determined to be high risk are managed in Complex Care Management. Members who are moderate risk with one or more of five chronic conditions (asthma, CAD, CHF, COPD, and diabetes) are managed in disease management.
Complex care management is defined as the coordination of care and services provided to members who have experienced a critical event or diagnosis requiring the extensive use of resources and who need help navigating the system to facilitate appropriate delivery of care and services. ConnectiCare’s program goal is to help members regain optimum health or improved functional capability in the right setting and in a cost-effective manner.
Disease management is defined as the process of assessment, planning, coordination of services and education with a focus on specific chronic conditions such as diabetes, asthma, heart failure, coronary artery disease (CAD), and chronic obstruction pulmonary disease (COPD). ConnectiCare’s disease management program is designed to produce the best possible outcomes for members, identify opportunities in care and service (e.g. closure of gaps in care), collaborate with providers about the member’s treatment plan in accordance with recommendations from national clinical guidelines and promote cost savings.
ConnectiCare also offers QuitCare, a smoking cessation program, for members who are ready to quit smoking. QuitCare is a telephonic program that includes unlimited quit coaching support from a Master Certified Tobacco Cessation Treatment Specialist, educational materials, coverage for over-the-counter nicotine replacement therapy (under the pharmacy benefit), and physician-prescribed medication for smoking cessation (also covered under the pharmacy benefit).
ConnectiCare develops and further enhances its TPH management programs in consultation with local physicians, primarily by leveraging the collaborative relationships we have with our provider groups and the practicing physicians who are voting members of ConnectiCare’s Quality Improvement Committee. Physicians regularly receive information from ConnectiCare about their patients including those who have been seeking non-urgent care at the emergency room, have clinical gaps in care, have an update to their authorization status or are enrolled in TPH care management. Any confidential member information received should be filed in the member’s medical record. If you do not want to receive these mailings, please contact our TPH Care Management Department at 800-390-3522.
More urgent updates may be deemed necessary by the TPH care manager in the event a member's health condition has changed. In this instance, the care manager will attempt to contact the doctor by phone.
If you would like to know more about ConnectiCare’s TPH management program content, printed copies of the TPH program-care management description, educational materials and mailings to members are available upon request.
ConnectiCare also relies on practitioners to refer patients to TPH care management.
Practitioner Rights
Practitioners who participate in ConnectiCare’s TPH management programs have the right to:
- Have information about ConnectiCare’s programs and services, including the staff, the staff qualifications, and any contractual relationships related to TPH management programs.
- Be informed of how ConnectiCare’s programs coordinate interventions with treatment plans for individual members.
- Know how to contact the person responsible for managing and communicating with the practitioner's patients.
- Be supported by ConnectiCare’s programs to make decisions interactively with members regarding their health care.
- Receive courteous and respectful treatment from ConnectiCare staff.
- Communicate complaints to ConnectiCare.
- Decline participation in TPH management programs.
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