Providers

Health Management Operations

A Helpful Resource

At iCare, we make our resources available to our network physicians, to help them provide quality care for their patients. We actively coordinate member care, which benefits providers when treating difficult cases. Our Health Management Operations department conducts care coordination through a multi-disciplinary model of care management. We recognize that in order to treat complex populations, we have to address social and behavioral health issues in order to treat medical conditions.

Some of the elements involved in iCare's Health Management Operations approach to care management involves the following:

• Conduct a comprehensive assessment to identify members’ medical, behavioral and social needs.
• Create a dynamic care plan with the member that addresses and prioritizes their needs and goals.
• Monitor member progress toward goals.
• Identify resources to meet member needs.
• Coordinate service provision with providers and members.
• Assist members with accessing services.
• Work with members to promote behavioral change and self empowerment to achieve improved quality of life.
• Monitor hospital experiences for treatment progress and appropriate discharge planning.
• Coordinate provision of appropriate care following acute care experiences.
• Facilitate provision of services along the continuum of care needs.
• Engage members in health promotion through education about resource utilization, disease management and self care.
• Monitor service provision for quality of care.
• Implement quality improvement initiatives.

Ultimately, the iCare process helps ensure patient compliance with treatment plans, a challenge when working with special needs populations. Besides serving as a resource for both members and providers, we are there to support physicians who need help with challenging cases. The support system for providers is multi-disciplinary, which includes pharmacy, behavioral health, translation services, as well as member data.

We can facilitate the use of alternative delivery options for the provider to use when treating challenging cases. Since we follow members on a continuous basis, we can advise the provider as to whether treatments have been tried and if they have been successful. By providing this level of collaboration and resources, iCare lends providers another mechanism to "nudge" members into compliance with their treatment plan.

With iCare, providers have extra tools to ensure something as simple as more members attending appointments, or as complex as providing multi-disciplinary support in a comprehensive treatment plan.

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