Medical Case Management Program

The HealthPlus of Michigan Medical Case Management program is comprised of licensed, registered nurses and social workers.  The primary goals of the HealthPlus Medical Case Management program are to:

1. Help members regain and improve health or function
2. Improve the member’s quality of life
3. Achieve the best possible clinical outcomes
4. Improve the self-management of diseases and conditions
5. Reduce unplanned hospital admissions and emergency room usage
6. Improve medication knowledge
7. Educate the member and family about preventive care
8. Ensure care is delivered in the right setting, at the right time 

Medical case managers monitor the member’s progress, evaluate his/her health status and update the case management plan as the member’s condition and/or circumstances change.  Medical case managers and social workers work together to coordinate financial, social, psychosocial, transportation, and environmental services for members, as needed.

The Medical Case Management program has two components: Complex Case Management (CCM) and Primary Case Management (PCM). 

Complex Case Management

Complex Case Management (CCM) is available to members who have had a major health event or diagnosis that requires the extensive use of healthcare resources.  Members who qualify for CCM may encounter barriers to getting needed care and need help navigating the healthcare system.  These members may also be receiving treatment from many doctors and providers, have problems following treatment plans, and have competing psychosocial concerns.  Complex case managers coordinate member care with the help of the member’s practitioners,family, friends and/or community agencies to ensure that needed care is received.

Primary Case Management

Members who do not qualify for CCM may be eligible for Primary Case Management (PCM).  PCM focuses on cardiovascular disease, diabetes, and asthma.  Primary case managers are also dedicated to helping members who have recently been discharged from the hospital or have utilized the emergency rooms. The goal of Primary Case Management is to promote self-management through education.  They strive to help to meet the day-to-day needs of a member living with a chronic condition utilizing evidence-based guidelines. 

Updated 08/03/07