Last Updated on June 15, 2022
The caring team at Health Choice 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 care 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 care management enrollment.
Health Risk Assessment
All new members of Health Choice 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 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 care management programs are designed to improve the quality of life for members with chronic diseases and complex conditions. Programs include:
Complex Care Management – The Complex Care Management Program is designed to provide high quality care 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.
Integrated Care Management – High Needs/High Cost members are eligible if they have a Serious Mental Illness (SMI) designation, and TX19 AHCCCS coverage. These members are assigned an Integrated Care Manager (ICM) who coordinates care with the member’s behavioral health and physical health providers to improve the member’s health outcomes. An Integrated Care Management Plan which includes ED/Inpatient/pharmacy utilization history data and care alerts, is shared with the member’s care team.
Disease Management – Health Choice’s Disease Management Programs deliver support for members with the following conditions: asthma, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, high or low BMI, hepatitis C while on antiviral therapy, hyperlipidemia, hypertension, HIV, and chronic high opiate or benzodiazepine utilization. The goals of the programs are to improve the member’s quality of life, awareness of and self-management of medical conditions, and overall adherence to their plan of care. The programs vary based on member population needs, with interventions including direct member outreach and education, educational member mailings, provider toolkits with patient registries, and prescription gap letters sent to prescribers. An integrated care training series which explains the basics of these chronic health conditions and other integrated care topics to behavioral health staff is free and available through Relias Learning by searching for “Integrated Care Training Series.”
SHOUT Protocol – SHOUT is a suicide prevention program for members with qualifying high risk suicide attempt(s) in the past 12 months. Members are assigned an Integrated Care Manager who follows the member for 12 months. Members are staffed monthly with their assigned Integrated Health Home, PCP or Provider Specialist to ensure that the protocol is being followed and that wrap-around services are in place for the member. Coordination of care is completed with all providers.
BOWS Prevention Protocol – The Benzodiazepine and Opiate Warning Signs (BOWS) Prevention Protocol is for members who show warning signs of a potential overdose on benzodiazepines or opiates. Health Choice care management staff coordinate care between prescribers and the member’s behavioral health home to reduce the risk of overdose and death. The program focuses on ensuring that all members of the care team are alerted to the risk and respond by enacting safety measures. Providers should submit an Incident, Accident, Death report for all BOWS warning sign incidents.
- BOWS Prevention Protocol for Integrated Health Homes
- BOWS Prevention Protocol for PCP & Pain Management
Opioid Care Management –Members, including those with T19 and non-T19 funding, are eligible if they have an opioid use disorder. These members are assigned to a Care Manager who will actively oversee the member’s care through monthly updates with the member’s Health Home, PCP, and other integrated providers on the member’s treatment team. An Integrated Care Management Plan is completed every 3, 6, or 12 months depending on the member’s need and sent to appropriate integrated providers for coordination of care. Members may be referred to Opioid Care Management by sources including but not limited to: jails, health homes, utilization management, BOWS, SHOUT, PCP, hospitals, ICM’s, QOC, pain specialists, or the member.
Wayspring – Wayspring partners with Health Choice to offer enhanced services related to opiate use and risk. Through the Risk Mitigation program, Wayspring works closely with opiate prescribers to reduce clinical risk and improve member outcomes. The Recovery Solutions program will offer direct support to members at risk of relapse after a discharge from ASAM level 3&4 facilities.
Justice Reach In Program – The Justice Reach In program provides support and coordination for members transitioning out of the justice system back into the community.
For more information on any of the Health Choice care management programs, or to make a referral:
- Call the Health Choice Member Services Line: 1-800-322-8670
- Completed referral forms and any pertinent medical documentation may be sent to the Care Management Department by fax to (480) 317-3358 or secure email to HCH.HCICICM@azblue.com
Selected Provider Program
Health Choice’s Selected 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 care 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 Selected 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 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