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Medica Administrative Manual Home > Health Management and Quality Improvement Care Management > Adult Case Management Programs

Adult Case Management Programs

Complex Adult Case Management

  • Case managers work with members and caregivers to insure access to services to allow members to remain in their home for as long as possible.
  • This includes assessing for home care needs, insuring compliance to treatment plan by maintaining physician visit appointment and coordinating care with specialty physicians, as needed.
  • Case managers are seeing an increase in the need to coordinate care and services for the elderly whose family members are geographically unable to assist with these needs.

Predictive Model Program

  • A program to identify members who are “predicted high-cost” for purposes of case management.
  • The case manager works with the member to identify mutually agreed upon health goals.
  • The case manager establishes a schedule of follow-up sessions that are agreeable to both parties.
  • Creates an action plan to meet the identified goals.
  • Goals are monitored for completion.
Date: 8/7/2020 4:14:28 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB01