female or male, etc.). For Facility the options are (location, network, type, or service), Provider search options by
Location, (within miles of members location, entering zip code or member’s address). Additionally, one can search
by providing more details (provider’s gender, patient’s age, other languages spoken, or provider’s name, etc.)
Provider search by Coverage and Care Requirements-select network, provider type, specialty, service, or hospital
affiliation. This feature includes a coverage map for these providers.
No questions from participants - one comment from Helen that provider search appears more user friendly.
5.
Coordination of Services – Case Management
Leizl will be discussing the levels of Case Management services not provided by CCHP staff and are provided by
contracted providers.
Enhanced Care Management (ECM).
ECM is the most intensive service provided. Case managers meet patients where they are, therefore, in-person
meetings are scheduled once a month. It is only available to Medi-Cal members only.
Who can get this help? (Participation is voluntary)
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CCHP Medi-Cal member:
Populations of Focus (defined by State) - Patients w/ complex health or social needs
Patients needing extra support managing their health
What ECM offers:
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o
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o
o
o
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Intensive, whole-person care coordination
Support with medical, behavioral, and social need
Help from a CCHP-contracted ECM provider
CM works w/ patients, their family and their doctor(s)
Information on the website and contact information to enroll in service were provided.
Complex Case Management
Available to both Medi-Cal and Commercial Members who don’t quite qualify for ECM
Who can get this help? (Participation is voluntary)
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2+ hospital stays last year (1 related to chronic condition)
3+ ER visits in the last 6 months (1 related to chronic condition)
Or take 15+ medications
Help managing transplant (pre/post-transplant care
What kinds of support are offered:
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Full review of medical, emotional and social needs
Custom care plan built around your goals
Coordination w/ patient’s doctor(s) and care team
Information on the website and contact information to enroll in service were provided.
Care Coordination
This is for patient’s short-term or one-time needs. A little bit lower level of case management designed for
providing support for members with short-term or episodic needs
Who can get this? (Participation is voluntary)
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Available to Medi-Cal and commercial members
Members with short-term or one-time needs
Patients who don’t meet ECM or Complex Case Management criteria
How We Help:
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Short-term support from CM
Assistance in finding services and resources
Care Team Coordination
Create personal care plan (specifically for each patient)
Information on the website and contact information to enroll in service were provided.
Transitional Care Service