The caring team at Health Choice Arizona uses advanced technology to improve the health care experience of members through a sophisticated care management platform that:
- Provides health risk assessments for all plan members encompassing medical, psychosocial, cognitive and functional measures.
- Identifies members who can benefit from case management and disease management.
- Facilitates collaboration between interdisciplinary care teams to better manage members’ care plans.
- Facilitates the evaluation of care effectiveness.
- Meets stringent care management requirements for CMS and Medicaid.
Our care management platform gives providers additional tools to assist patient care, including:
- Submission of web-based authorization requests.
- Review status of authorization and referral requests.
- Ability to request case management enrollment.
Health Risk Assessment
All new members of Health Choice Arizona are given a health risk assessment that evaluates several factors, including medical, psychosocial, cognitive and functional measures. After the initial assessment, if a risk is identified, the member is offered and encouraged to enroll in a specialized health care management program which is designed with individualized care plans for achieving health care goals.
Additionally, our care management platform gives our team of qualified case managers, care coordinators and medical professionals the ability to monitor and identify patients whose health status has changed and may benefit from disease and/or care coordination.
Our comprehensive disease and case management programs are designed to improve the quality of life for members with chronic diseases and complex conditions. Programs include:
Asthma –The goal of the Asthma Program is to improve the quality of life for qualifying members age five years or older.
Diabetic – The Diabetic Program is designed to improve HbA1c testing and levels among diabetic members. Members will also increase disease awareness and self-management of their medical condition(s).
Hepatitis C – This program was developed to improve medication adherence for members diagnosed with Hepatitis C and to improve overall compliance with the member’s care plan.
Complex Case Management – The Complex Case Management Program is designed to provide high quality case management to members with multiple and/or complex, and/or catastrophic injuries, the frail and elderly, members in Special Needs Plans (SNP) and other members with high risk health conditions.
Selective Provider Program
Health Choice Arizona’s Selective Provider Program facilitates increased oversight of appropriate medical service utilization. This is accomplished by having an assigned provider as a point of coordination, for treatment planning and/or outpatient pharmacy prescription fills. Outpatient providers are informed of service utilization and opportunities for coordination of care with other treating providers. Interventions include a case management component to promote adherence to outpatient treatment plans and to help member’s work on behaviors that often contribute to decreased health care such as:
- non-adherence to treatment plan
- lack of appointment attendance
- problems understanding outpatient treatment plan
- problems with adherence to medication instructions
- need for mental health or substance abuse treatment
- need for fostering good doctor/patient relationships
Members are identified for enrollment in the Selective Provider Program when a need for additional service structured interventions are warranted, to address overutilization and support member engagement in appropriate outpatient medical/behavioral health care.
Prescription utilization data is reviewed for:
- combinations of therapeutic classes of abuse potential drugs (Opioids, Benzodiazepines, Stimulants, Muscle Relaxants, Hypnotics, Atypical Antipsychotics)
- early or overlapping fills within a class of abuse potential drugs
- multiple providers prescribing the same or similar abuse potential drug
- multiple pharmacies dispensing the same or similar abuse potential drug
Pregnant women can register for our Stork Program to receive information and guidance from our maternity nurses to help them have a healthy pregnancy. Our Stork Program will also help pregnant women and new moms obtain the community resources they need for their family.
Healthy Kids & Families
At Health Choice Arizona our goal is to keep you and your children healthy. We believe that a healthy start in life will allow them to have a bright future!
The Healthy Start, Bright Futures children’s campaign focuses on six pillars for a healthy life:
- Annual well visits
- Dental visits