Piedmont’s Case Management Program is a service that helps members of Piedmont Community Health Plan, who have complex or multiple conditions, manage their health issues so they can be as healthy and active as possible. The program is entirely voluntary. The member decision whether or not to participate will not affect your insurance coverage. If the member decides to participate, and later change your mind, the member can leave the program at any time.
The diagram below gives an overview of the Case Management Program and outlines Piedmont’s strategy to address our member’s healthcare needs and to promote wellness and positive lifestyle choices.
The goal of the programs is to improve the member quality of life by helping to manage difficult and chronic conditions while helping you to make appropriate lifestyle choices. Making these changes and following your doctor’s plan of care will improve how you manage your health conditions.
How It Works
Each member who requests and qualifies for participation in any of the Case Management Programs will be assigned to a specific condition area. A Piedmont Case Manager will do an initial evaluation and then follow the member's case while working closely with you and / or your doctor. The Case Manager will offer support, but you - the member - will ultimately learn to take a more proactive role in making healthy changes.
Also, with participation in any of our Case Management Programs we will help you to take full advantage of your Piedmont benefits. This service enables you to make sure you are getting the most effective and cost efficient treatments available from your healthcare plan.
This is a “Total Population Health Management Program” that focuses on the individual and the issues or conditions that may affect his or her health over a continuum of time. This comprehensive approach to care management is divided into four key areas:
III. Complex Case Management
III. Disease Management
III. Condition Care Program
IV. Lifestyle Management
I. Complex Case Management Program
The Complex Case Management program is designed for members with multiple or chronic conditions resulting in more complex healthcare needs. The primary goal here is to help the member manage your health conditions with assistance on such things as:
- Appointments - assisting members in making appropriate physician appointments, as well as referrals when they are needed.
- Education - helps identify and locate resources and materials to keep you up to date on your condition.
- Community resources - helping members to attain resources from the community such as financial assistance and transportation.
- Home Health Care - getting referrals if needed.
- Prescriptions- providing education and compliance with the member’s employer plan drug formulary.
II. Disease Management Program (top)
As previously mentioned, members participating in any of the Disease Management programs below will be contacted by a Piedmont Nurse Case Manager (NCM) who will be assigned to your case to help with specific disease conditions associated with:
- Chronic Obstructive Pulmonary Diseases (COPD)
- Congestive Heart Failure (CHF)
- End Stage Renal Disease (ESRD)
All of these conditions are overseen by the Piedmont Case Manager who specializes in that area, such as our onsite Certified Diabetes Educator. This is a tremendous resource for those who are dealing with long-term conditions such as cancer, diabetes, COPD, and ESRD.
III. Condition Care Program (top)
This area of the overall Case Management program deals with less invasive conditions and situations such as:
1. Behavioral Health Case Management
Your Piedmont Mental Health Case Manager will provide you with information on:
- Appropriate treatment facilities
- Choosing a counselor, or psychiatrist in the network
- Explanation of your plan’s mental health benefits
2. Post Surgical Case Management
Here Piedmont helps to reduce possible hospital readmissions by:
- Keeping you in contact with a PCHP nurse
- Reviewing post-op condition with the patient and family members
- Handling any continuing care
Frequently Asked Questions:
What can I expect from the Piedmont Case Management and Disease Management Programs?
The Piedmont Case Manager will work with you and / or your doctor, or nurse practitioner, to help you manage your health conditions. This can be done by telephone or pre-arranged contacts. The Case Manager will also provide education, resource assistance and help in navigating the complex healthcare system. You will continue to see your doctor, or nurse practitioner for medical care. Contacts can be made as frequently as necessary to assess your progress.
How will the Piedmont Case Management and Disease Management Programs help me?
These programs will assist you in managing your health conditions and taking care of yourself. If you choose to involve family members or care-givers, we can also help them to better understand your conditions and needs. The Case Manager helps you make appropriate decisions about your care and makes sure that you are receiving the right services and the right support.
For example, your Piedmont NCM may make appropriate recommendations for you on subjects such as:
- Preventive care programs
- Mental Health programs
- Lifestyle programs such as nutrition, smoking cessation and weight management
- Community resource assistance, rehabilitation, skilled nursing and home services
So let us support you as you learn to live better with your health conditions. To contact a Piedmont Case Manager call: 434-947-4463, or 800-400-PCHP.