Case management support
Case management support
- Member identification and screening
- Initial and ongoing assessment
- Problem-based, comprehensive care planning that includes measurable goals and interventions tailored to the acuity level of the member, as determined by the initial assessment
- Coordination of care with primary care providers and specialty providers
- Member education
- Effective member and provider communication
- Program monitoring and evaluation using quantitative and qualitative analysis of data
- Satisfaction and quality of life measurement
- Maintain a cost-effective case management system to manage the needs of members with high case management needs in one or more domains (physical, behavioral or social).
- Utilize targeted high intensity interventions that include the option of in-person interactions with a specific identified group of members define by the state as “super-utilizers” due to excessive utilization patterns.
- Identify barriers that may impede members from achieving optimal health.
- Implement agreed-upon interventions to increase the likelihood of improved health outcomes, improving quality of life.
- Reach out to effectively engage members and their families as partners in the case management process.
- Reduce unnecessary, duplicated and/or fragmented utilization of health care resources.
- Promote collaboration and coordination (at all levels of the health care delivery system) between physical health, behavioral health, the pharmacy program and community-based social programs.
- Foster improved coordination and communication among providers and with Dell Children’s Health Plan staff.
- Improve member and provider satisfaction and retention.
- Comply with applicable contractual and regulatory requirements related to case management.
- Identify opportunities to transition members to more appropriate federal/state programs (e.g., from STAR to STAR Kids or STAR+PLUS).
- Serve as advocates for members.
- Assist members to match available benefits to their health care needs.
- Promote effective strategies to prevent or delay relapse or recurrence through interventions, such as member education and improved member self-management.
- Coordinate case management interventions with ongoing health promotion initiatives, such as dissemination of member education literature.
- Help members and their families mobilize internal and external resources and strengths to improve their health outcomes and manage the costs of care.
- Provide culturally-competent case management services to members, families and providers.
- Maintain the highest quality of ethical standards, including maintenance of confidentiality, in all dealings with members.
- Conduct quality management and improvement activities to ensure the highest possible level of service to members and their families.
- Monitor outcomes of interventions to assist in evaluating and improving programs.
Any Dell Children’s Health Plan member is eligible for service coordination. Members are identified through continuous case-finding methods that include but are not limited to precertification, admission review and/or provider or member/caregiver requests.
Comprehensive member assessment
A service coordinator will conduct a comprehensive assessment to further determine a member’s needs.
To contact a service coordinator, call Service Coordination at 512-324-3015 or toll free 1-844-964-3015.
- Behavioral health: 1-800-424-1764
- Service Coordination: 1-844-964-3015
- Member Services: 1-855-921-6284 TTY 711
- Navitus (PBM): 1-877-908-6023
- Provider Services (Claims status, eligibility and benefits): 1-844-781-2343
- Provider Relations Department: 512-324-3125, Option 4
- Superior Vision of Texas: 1-877-235-5317
- Utilization Management Department: 1-855-962-4453
- Access2Care (Transportation): 1-844-867-2742
Disease Management Overview
Our disease management program is based on a system of coordinated care management interventions and communications designed to help physicians and other healthcare professionals manage members with chronic conditions. Our services include a holistic, member-centric case management approach that allows service coordinators to focus on multiple needs of members. Our disease management programs include:
- ADHD
- Asthma
- Congestive heart failure
- Chronic obstructive pulmonary disease
- Diabetes
- Hypertension
- Major depressive disorder
- Weight management
- Substance use disorder
- And more
In addition to our 9 condition-specific disease management programs, our member-centric, holistic approach also allows us to manage members with obesity.
All members with diagnoses of the above conditions are eligible for Disease Management services.
Members are identified through activities such as continuous case finding, welcome calls and referrals.
As a valued provider, you can refer patients who can benefit from additional education and service coordination support.
- Proactive identification process
- Evidence-based clinical practice guidelines from recognized sources
- Collaborative practice models that include the physician, and support providers in treatment planning
- Ongoing process and outcomes measurement, evaluation and management
- Ongoing communication with providers regarding patient status
- Continuous patient self-management education including:
- Primary prevention
- Behavior modification programs and compliance/surveillance
- Home visits and service coordination for high-risk members
Our disease management programs are based on nationally approved clinical practice guidelines. A copy of the guidelines can be printed from the website, or call provider services at 1-844-781-2343 to receive a copy.
Our service coordinators will work collaboratively with you to obtain your input in the development of care plans. Members identified for participation in any of the programs are assessed and risk-stratified based on the severity of their disease. They are provided with continuous education on self-management concepts, including primary prevention, behavior modification and compliance/surveillance, as well as service coordination for high-risk members. Program evaluation, outcome measurement and process improvement are built into all the programs. Providers are given telephonic and/or written updates regarding patient status and progress.
- Calling Case Management at 512-324-3015; 1-844-964-3015 or
- Faxing a completed Case Management Referral form to 512-324-3016.
You have the right to:
- Have information about Dell Children’s Health Plan, including:
- Provided programs and services
- Our staff
- Our staff’s qualifications
- Any contractual relationships
- Decline to participate in or work with any of our programs and services for your patients
- Be informed of how we coordinate our interventions with your patients’ treatment plans
- Know how to contact the person who manages and communicates with your patients
- Be supported by our organization when interacting with patients to make decisions about their health care
- Receive courteous and respectful treatment from our staff
- Communicate complaints about our disease management program as outlined in the Dell Children’s Health Plan Provider Manual
These rights and responsibilities are available to you in written format upon request to Disease Management by calling 512-324-3015 or toll free 1-844-964-3015.
The disease management program does not advertise, market or promote specific products or services to members or providers. The disease management programs do not have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.
