Care Management

Our Care Management team is here to help you make informed decisions to effectively manage your health and well-being.

Care Management is one of the most effective ways Health New England is able to help our members better manage their health. Our Care Management program is designed to address the whole individual and includes appropriate interventions for members along the entire continuum of care; reducing health risks and improving health outcomes.

Benefits of Care Management

Care Management will help you get the care and services you need to manage your health and complex medical conditions.

Care Management may also focus on specific concerns such as:

  • Asthma
  • Behavioral Health
  • Chronic Obstructive Pulmonary Disease
  • Congestive Heart Failure
  • Coronary Artery Disease
   
  • Depression
  • Diabetes
  • High-Risk Pregnancy
  • Substance Use Disorder
 

We can help identify community resources for your family and caregivers, help you navigate the complexities of the care system, and help you with referrals and other common care needs to help you stay healthy.

Our program offers a team-based, member-centered approach, comprised of licensed nurses and social workers acting as clinical advocates. Programs are available for all of our members, regardless of age or type of health plan. We address cultural backgrounds and offer multilingual services when required.

How it Works

We identify members for our Care Management programs through claims data, physician referrals and/or self-referrals. When you are referred* to our program, a Care Coordinator or Care Manager will reach out to you to determine your care needs. Once you are enrolled into a program, your Care Manager will develop an individualized care plan specific to your unique care needs and help you manage your health conditions and risk factors through regular phone calls and check-in appointments.

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Available Programs

Behavioral Health 

Depression Program


Those struggling with depression know that it has serious effects on their overall health, daily functioning and the lives of their families and loved ones. Our Depression Case Management Program provides support for our members that include: arranging, coordinating and advocating for services such as counseling, crisis services, community resources and support groups.

Mental Health


Mental health problems have a real effect on daily living activities and an impact on overall quality of life. Our Mental Health Case Management Program works with our members to help find them the services they need such as educational materials and referrals to counseling, medication management, day programs, state agencies, and community resources.

Substance Use Disorder


Excessive alcohol and illicit drug use can have a serious effect on individuals and their families. Our Substance Abuse Case Management Program assists members with locating inpatient substance abuse programs, making referrals to outpatient services, and connecting member with crisis services, support groups, medication assisted treatment, and family supportive services.

Social Case Management


The conditions in which people are born, grow, live, work, and age affect their overall health and well-being. Our Social Case Management program seeks to help members meet not only their health needs, but their environmental and basic living needs. We help our members find resources like safe, affordable housing, healthy and affordable food, affordable medication and community resources and support groups.

Complex Care Management  

Members with complex medical needs who require a variety of resources to manage their health and improve their quality of life will benefit from our Complex Care Management program. The program provides members with services that assist in managing acute or chronic conditions using education, communication and available resources to promote quality outcomes.

Care Coordination  

Sometimes members require assistance in coordinating activities to help meet their needs for health services, education, and communication. Our Care Coordination program helps organize care activities between multiple providers, facilitates the appropriate delivery of health services, and assists members in gaining access to necessary care and resources.

Disease Management  

Asthma


Symptoms of asthma range from mild coughing, wheezing, and tightness in the chest, to more serious symptoms like difficulty breathing, and inability to talk in full sentences without losing your breath. If you have been diagnosed with asthma, our Asthma program is designed to help support your provider’s plan of care, provide educational materials and coaching as well as guidance on lifestyle changes, managing exacerbations and use of medications.

Chronic Obstructive Pulmonary Disease


Symptoms of Chronic Obstructive Pulmonary Disease (COPD) include chronic cough, difficulty breathing, wheezing, tightness in your chest, frequent respiratory infections and lack of energy. If you have been diagnosed with COPD, our COPD program is designed to help support your provider’s plan of care, provide educational materials and coaching as well as guidance on lifestyle changes, managing exacerbations and use of medications.

Congestive Heart Failure


Those with Congestive Heart Failure (CHF) struggle with shortness of breath, fatigue, swelling and sudden weight gain from fluid retention, lack of appetite and nausea, and persistent cough or wheezing. Our CHF program supports your provider’s plan of care and your self-management by guiding you with your medications, daily weights, fluid and salt restriction and healthy lifestyle habits.

Coronary Artery Disease


Coronary Artery Disease occurs when an artery that supplies blood to the heart muscle becomes narrowed and the heart does not receive enough blood or oxygen. This can lead to chest pain, shortness of breath or a heart attack Our Coronary Artery Disease program provides members with educational materials, coaching and tools to help control high blood pressure, prevent progression of coronary artery disease, and maintain quality of life.

Diabetes


Diabetes is a disease in which the body is unable to properly use and store glucose (a form of sugar). With good diet, exercise and medication management, people with diabetes can live a full and normal life. Risks of uncontrolled diabetes include kidney disease, heart disease and blindness. If you have been diagnosed with diabetes, our care managers can help support your provider’s plan of care and provide educational materials and coaching as well as guidance on diet, exercise, testing, and use of medications.

High Risk Maternity


Pregnancy is a special time for expectant mothers and most can look forward to delivery of a healthy baby at full term – 37 weeks or more gestation. However, preterm births are more common than you might think. Our High Risk Maternity Program identifies potentially high-risk pregnancies as early as possible and provides support to promote healthy and uncomplicated pregnancy, labor and delivery.

Hypertension


One in three American adults has hypertension or high blood pressure, a condition that can result in heart disease or stroke. If you have been diagnosed with hypertension, our Hypertension program can provide you with educational materials and work with you and your provider to address ways to reduce and control your blood pressure such as eating a healthier diet, exercising regularly and if you smoke, help you to quit.

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Getting Started

If you or any of your family members are interested in Care Management, help is only a call away. You can enroll by calling our Care Management team today at (800) 842-4464 or (413) 787-4000, ext. 3940.

You can also enroll by completing our Referral Form and submitting it back to us by mail or fax:

Mail:Health New England
Attn: Care Management Program
One Monarch Place, Suite 1500
Springfield, MA 01144-1500

Fax: (413) 233-2700


*Care Management is not mandatory. If you receive a call from a Care Manager, you have the ability to opt out of the program. We encourage you to take advantage of this resource to help you manage your health and well-being.