Health Services
The Health Services Department assures that members receive the services that they need and that those services are provided in a timely as well as effective manner.  If needed, members are assisted in obtaining appointments and receiving specialty care and/or ancillary care.  Members are directed to Health Plus participating providers. However, if a participating provider is not available, then non-participating providers will be given the information and authorization they need to see Health Plus members.

Disease Management is provided for members with chronic illnesses, such as asthma or diabetes, to ensure that they receive appropriate health education and services.  Health Services identifies members in need of extensive interventions and initiates the coordination of such services through Case Management.  Members who are case managed are assigned to one clinical staff person, who assists the member in accessing care, coordination of services, and communication with the Primary Care Physician, as well as other healthcare providers.

Health Services monitors all hospitalized members and makes sure they receive care as ordered by their physician.  Upon discharge from the hospital, arrangements are made for any home medical care, equipment and supplies that the member might need.  Post-discharge follow up calls are made to members with complex needs.

If any problems are found within the healthcare delivery system, the Health Services Department reports them to the Medical Director and/or the QI Department.  Health Services provides statistics regarding clinical services used by members for use in financial and resource planning, including the addition of medical services.