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Complex Case Management and Care Coordination

The Complex Case Management team provides the following support for members:

Comprehensive assessments.
Promotion of the patient-centered medical home by facilitating a safe connection between our members, their caregivers and their PCPs.
Care coordination.
Promotion of health self-management efforts.
Referrals to community resources.
Mutually agreed upon, individualized care plans that include targeted interventions.
Patient engagement through phone and in-person encounters.

To find out more about care management for TotalCare (HMO D-SNP) members, please visit our TotalCare (HMO D-SNP) Care Management and Care Coordination page. TotalCare members with complex medical, behavioral health, functional or social needs may be eligible for California Integrated Care Management (CICM).

Patients Suited for Complex Case Management Services

Complex Case Management is suitable for patients in the following situations:

Member is CCS-eligible or being evaluated for CCS-eligible conditions.
Chronic illness.
- Poorly controlled chronic illness or new/worsening complications (e.g., asthma and diabetes).
- Obesity/bariatric patients.
- Medication reconciliation.
- Multiple inpatient admissions.
Catastrophic diagnosis.
- Complex injuries.
- HIV/AIDS (new diagnoses and unlinked).
- End of life.
Medical issues.
- Complicated wounds.
- Stroke with complications.
- New or worsening debilitating disease (e.g., multiple sclerosis, Parkinson’s disease).
- Seizure disorder with complications.

Patients Not Suited for Complex Case Management Services

Care Coordination

The Care Coordination team helps members with less complex, non-clinical needs by providing:

Information for new Alliance members about their health plan.
Referrals to community resources and services.
Follow-up care with specialists, including referrals for ancillary services and durable medical equipment (DME).
Assistance with making and keeping appointments.
Help retrieving medical records.