Take Advantage of Health Plus Case Management Services

Health Plus Case Management services are designed to support providers in managing members with complex acute or chronic conditions (see examples below). Health Plus Case Managers (registered nurses or certified social workers) assist providers in coordinating a variety of care and support services for members with serious medical and/or behavioral health conditions. An active partnership is created between the member, his/her PCP (Primary Care Physician), and the Health Plus Case Manager.

Members Targeted

Conditions such as:

• HIV/AIDS
• Organ Transplants
• Renal Failure
• High Risk Maternity
• Neonatal ICU
• Trauma with Multiple Disabilities
• Asthma with high admissions
• Diabetics w/ HgbA1c >9
• Severe behavioral health problems

Interventions

Each member accepted into Case Management is assigned to an individual Case Manager (an RN or CSW) who performs an in-depth assessment and works closely with the member and his/her PCP to coordinate a variety of care and support services.

Contact with Provider

The Case Manager communicates frequently with the member's PCP, specialists, and allied health providers in order to coordinate care and services.

How to Refer Members

Providers can refer members for these important services by calling the Health Plus Provider Care Center at 800-450-8753. A Case Management referral form can also be downloaded here. Once completed, the form should be faxed to 718-360-1314 for medical referrals or to 718-504-7112 for behavioral health referrals.

A Case Management Success Story

A 14 year-old boy became paralyzed after a severe neck injury sustained in a car accident and subsequently developed a cyst on his spine. He was referred to Case Management and received DME (durable medical equipment, such as a tub bench and wheel chair), visiting nurse services, physical therapy, and social work support, all arranged by his Case Manager in conjunction with his PCP. After only six weeks in Case Management, this member was well enough to begin classes at one of New York City's top high schools.