Priority Partners is happy to offer a one-of-a-kind health program for our plan members … at no cost!
Participating members are put in one of three levels. Depending on the member’s level, they will get a variety of support, tools, and services that will help them to better understand and manage their condition.
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This level is for members with complex medical conditions such as diabetes, asthma, congestive heart failure, Chronic Obstructive Pulminary Disease (COPD), or multiple conditions. Members in this level will be called by a care manager who will watch their health status, help them make a self-management plan, and help them to find the right care. Some examples of conditions that qualify for this level are:
- High risk pregnancy
- Cardiovascular disease
- End stage renal disease
- Serious pediatric conditions
- Stroke, spinal cord or brain injuries that require rehabilitation
What is a care manager?
Care managers are skilled nurses and social workers who provide support, guidance and encouragement in helping our members manage their health. Working closely with our members and their health care providers, care managers:
- Assess each member’s physical, psycho-social, spiritual and financial needs
- Educate members on ways to manage their health
- Assist with referrals to specialty providers
- Coordinate care with our outreach and health education department, home health and other health and community agencies
- Provide ongoing communication to check member’s progress and review for continuing services
Other population health-based services include:
- Periodic mailings of educational materials focused on increasing self-management skills and preventing complications
- Communicating to the member and health care provider about medical and pharmacy claims
- Review of medications and discussion with our clinical pharmacy services if needed
- Assistance with getting behavioral health services, provided by Care Management Treatment Coaches. This service can be reached by calling the toll-free number (888) 309-4573
- Assistance to members moving from a hospital to a lower level of care and then home. Staff works with providers, members, and families with discharge planning, care coordination, and member and family education
How to Self-Refer
Members with certain needs may be automatically enrolled but are under no obligation to participate in these programs. If you have questions about our Population Health Initiative or other Care Management services, or if you’d like to join a program, call (410) 762-5206 or toll-free at (800) 557-6916. We are available Monday through Friday, 8:00 AM- 5:00 PM.
For more information on any of the case/disease management programs, please call 1-800-557-6916 or e-mail at firstname.lastname@example.org.
*Please do not send any Protected Health Information (PHI) and personal medical information when using the e-mail links above. Please include contact information in case we need to reach you.