2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Care Coordinationmember across this integrated care continuum. ThePresbyterian care coordination team includes ouremployed staff and those of our experiencedbehavioral health partner, Magellan, for theCentennial Care Behavioral Health network. Somecare coordination team members have extensivebehavioral health and long-term care experience.They are available to be primary care coordinatorsor to consult with other providers of care formembers with co-morbid medical and behavioralhealth conditions and functional needs. The carecoordination team works under the leadership ofour senior medical director to bring an array ofclinical experience and cultural/linguisticcapabilities to the care coordination process.Our model leverages the experience andcapabilities of its provider partners along with localcommunity resources to ensure comprehensiveand culturally appropriate care coordination formembers. Presbyterian encourages care beingprovided through qualified Patient-CenteredMedical Homes and future health homes includingcare coordination services. Through thesearrangements, Presbyterian provides overarchingcare coordination services, technical assistance,and systematic monitoring to assure carecoordinators at these provider sites have access toPHP systems, resources, tools, utilization data, andencounter data required for effective carecoordination.Members are matched with an appropriate carecoordinator based on their clinical needs,geographic location, language, culturalpreferences, and history of established providerrelationships. To find out who your patient’sassigned care coordinator is, you may contact thecare coordination unit atPhone: 1-866-672-1242 or 505-923-8858Fax: 505-213-0063For Centennial Care members, based on theresults of the CNA, an individualized care plan isdeveloped for members assigned to a specific carecoordination level of care. The care plan aligns amember’s needs and preferences with appropriateservices and interventions, which include thesupport the member needs to stabilize or improvehis or her health, safety, and well-being. The careplan includes all Medicaid services, value-addedservices, and other supports or services identifiedfor the member.Care Plan Development – Centennial CareBased on the results of the CNA, an individualizedcare plan is developed for members assigned tocare coordination Level 2 or 3. The care plan alignsa member’s needs and preferences withappropriate services and interventions, whichinclude the support the member needs to stabilizeor improve his or her health, safety, and well-being.The care plan includes all Medicaid services, valueaddedservices, and other supports or servicesidentified for the member.This customized care plan allows the member tounderstand what services are available and createsa foundation for discussions about his or her healthamong the member, the member’s caregivers, carecoordinator, and providers. The assigned carecoordinator works with the member and his or her6-62014 Practitioner and Provider Manual - Ver. 3