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.
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.
Complex Case Management is not suitable for patients who are unreachable or refuse to participate.
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.
Care Management Resources
- General and suitability questions:
Phone: 800-700-3874, ext. 5512
- Fax: 831-430-5852