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Provider Manual

Chronic Care Management

Last Updated on August 28, 2018

Security Health Plan’s Chronic Care program is a chronic condition program that works with members over the age of 18 that have asthma, diabetes, CHF, COPD, hypertension, and/or hyperlipidemia to improve the coordination of care and self-management of our members with these conditions.  Members who have one or more of the chronic conditions listed above will receive targeted educational mailings and interactive voice recognition (IVR) calls that address any pertinent gaps in care.  High risk members will also receive telephonic outreach or in-person visits from a RN Care Manager for up to 90 days.  During this 90 day period, RN Care Managers will conduct clinical assessments of health status and co-morbidities, support a provider’s care plan, communicate regularly with the provider, make referrals to social workers, health coaches, and community resources, perform medication reconciliation, and educate the member in order to optimize the member’s ability to take care of him or herself.  Risk levels are based on a variety of factors including pharmacy and medical claims, predictive scoring, prior avoidable events, gaps in care, and medical condition intensity.

For more information about clinical practice guidelines, click here.