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.

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.