Care Management

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.

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.

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.

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.

Kidney Health Management

Health New England is partnering with Healthmap Solutions to provide more comprehensive care for Medicare members with Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD). Healthmap’s KHM program integrates into your existing practice workflow to reduce additional office work, while enhancing communication. Healthmap offers the best kidney health solution that will support you in providing care for your patients.

Our members identified as being at risk for CKD stage 3 and higher are included in the KHM program. Healthmap will contact you to schedule an overview of the program and to collaborate as you manage your patients with CKD and ESRD.

Individualized patient recommendations are addressed in two ways to achieve best outcomes: 

• Identification of patient opportunities/care-gaps related to medications, lab testing, specialty referrals and selective quality metrics
• Clinical support for you and your patients who may benefit from more personalized support based on disease intensity through Healthmap’s Care Navigation

The Care Navigation team provides complex care coordination services to support health care needs between office visits. Care Navigation supports the patient’s overall care and focuses on identifying and removing barriers that prevent a patient from achieving their optimal health.

Learn more at healthmapsolutions.com. For additional information, review this Healthmap Provider Packet or call the Health New England Dedicated Line at (800) 985-9208 to schedule an orientation or to refer patients.