Common use of Discharge Outreach Call Program Clause in Contracts

Discharge Outreach Call Program. The Discharge Outreach Call Program assists members in understanding their post-discharge treatment plan and thereby helps prevent avoidable complications and readmissions. Within two (2) days of discharge from a Hospital, a Keystone nurse may contact a member by telephone to discuss any discharge concerns; to assess the member’s understanding of and adherence to the provider’s discharge instructions, including the timing of any follow-up appointments; to determine the member’s understandings about any medications prescribed; and to make sure any necessary arrangements for services, such as home health care, are proceeding appropriately. Case Management Program The Case Management Program is a service for members with complex medical needs or who may be at risk for future adverse health events due to an existing medical condition or who may require a wide variety of resources, information, and specialized assistance to help them manage their health and improve their quality of life. The program assigns an experienced Keystone Case Management nurse or coordinator to a member or family caretaker to help make arrangements for needed care or to provide assistance in locating available community resources. Case Management services provided to members are numerous and are always tailored to the individual needs of a member. Participation in Keystone’s Case Management Program is voluntary and involves no additional cost to our members. Services often include, but are not limited to: • Assistance with coordination of care; • Discussion of disease processes; • Facilitating arrangements for complex surgical procedures, including organ and tissue transplants; • Facilitating arrangements for home services and supplies, such as durable medical equipment and home nursing care; or • Identification and referral to available community resources, programs; or organizations. DELEGATION OF UTILIZATION REVIEW ACTIVITIES AND CRITERIA‌ Utilization Review and Criteria for Behavioral Health Services Utilization Review activities for behavioral health services (Mental Health and Substance Abuse services) have been delegated by the HMO to its contracted behavioral health management company which administers the behavioral health Benefits for the majority of the HMO's Members. Members seeking Mental Health care and Substance Abuse services may obtain Preauthorization for such services from the contracted behavioral health management company. DISEASE MANAGEMENT PROGRAMS‌ The Disease Management Program is a collaborative program that assesses the health needs of Members with a chronic condition and provides education, counseling, and information designed to increase the Member’s self-management of this condition. The goals of Keystone Health Plan Central’s Disease Management Program are to maintain and improve the overall health status of Members with specific diseases through the provision of comprehensive education, monitoring and support for healthy self-management techniques. The Disease Management Program is especially beneficial for Members who have complex health care needs or who require additional assistance and support. Participation in Keystone Health Plan Central’s Disease Management Program is voluntary and involves no additional cost to our Members. MATERNITY MANAGEMENT PROGRAM‌ Precious Baby Prints® is a voluntary Maternity Management Program designed to support expectant mothers who experience both complicated and uncomplicated pregnancies. Program participation extends throughout pregnancy, delivery and postpartum care. The program provides educational information, teaching, and personalized support to pregnant members. The assessment phase of the program includes a questionnaire that helps to identify members who may be at risk for pregnancy-related complications or who may be experiencing complications. Members identified as being potentially at high risk for complications are assigned a Maternity Case Manager (R.N.) for more intensive personalized services. Program activities for low risk members are designed to supplement the advice and treatment provided by the member’s Obstetric provider and physicians. The program is tailored to each member’s individual health and educational needs and provides credible educational materials related to pregnancy, general health issues, childcare and parenting skills. QUALITY MANAGEMENT PROGRAM‌ The Quality Management Program is designed to facilitate the receipt of quality care and services by Keystone members. The program is multidisciplinary, involving all departments within Keystone that have a direct impact on quality of care, services and accessibility. The program provides for the monitoring, evaluation, measurement, and reporting of the quality of medical care, the quality of service, and the safety of program services. Responsibilities of the Quality Management Program include but are not limited to: • Clinical appeals and Grievances; • Identification, evaluation and corrective action (as necessary) for all potential quality issues; • Analysis of member satisfaction surveys; • Monitoring of provider practice patterns; and • Compliance with all regulatory and accrediting standards. HEALTH EDUCATION AND WELLNESS PROGRAMS‌ Keystone’s Health Education and Wellness Programs are provided through a special unit within the Clinical Management Department. Xxxxxxxx believes that motivating individuals to adopt healthier lifestyles results in better outcomes when individuals have access to comprehensive and accurate health and wellness information. In addition, the Health Education and Wellness Programs include a 24-Hour Nurse Line service that is available to all of our members free of charge and a Nicotine Cessation Program. Multiple areas on the Capital BlueCross website are dedicated to providing health and wellness education for our members. For more information, visit xxxxxxxxxxxx.xxx and xxxxxxxxxxxx.xxx.