Healthfirst Spectrum Care Management Programs
Ensuring you get the best care possible.
Chronic Care Improvement Program (CCIP)
This program emphasizes outreach, education and intervention for members with diabetes and depression. This program empowers our members to manage their health care condition, prevent the recurrence of admissions and improve their quality of life. The program is managed by the Medical Management staff for eligible Medicare members (on three (3) or more medications, one (1) of which is a hypoglycemic and one (1) is an anti-depressant) as identified through ESI data. Healthfirst is committed to increasing the quality of life and decreasing mortality and morbidity in the diabetic/depressed population. Emphasis of the program is based on member assessment and coordination of care with an inter- disciplinary team. Our highly trained team of nurses works telephonically, in clinics, emergency rooms and on units at several of our participating hospitals to address and enforce compliance, educate members about managing their condition, coordinate care, select services and weigh treatment options.
Healthfirst Care Managers are available to provide outreach to members who may be victims of domestic violence and to help them obtain needed services. Victims may include women, children, gay/lesbian partners or senior citizens. If you think a Healthfirst member may be a victim of abuse, please call a Healthfirst Care Manager at 1-866-463-6743
Healthfirst is committed to increasing the quality of life and decreasing mortality and morbidity in the HIV/AIDS population. Emphasis of the program is based on member assessment and coordination of care with the PCP, Infectious Disease Clinic, Immunologist or HIV Specialist Provider. The goal is member education, coordination of medical care to help prevent opportunistic infections, and early identification of behavioral health and/or community resource needs. This program was developed in accordance with HIV/AIDS clinical practice guidelines published by the AIDS Institute, New York State.
Healthy Mom/Healthy Baby
Healthfirst has implemented patient education programs and care management programs focused on pregnancy and newborn care. All pregnant women enrolled in these programs are sent educational materials endorsed by the March of Dimes. These include information about prenatal care, fetal development, nutrition, pre-term labor and vaccinations. Please contact the obstetrical case manager at 1-866-463-6743 regarding all pregnant Healthfirst members under your care so they can receive these educational materials. Members identified as ―high-risk‖are followed by a registered nurse for education, outreach and prenatal and postnatal care. Healthfirst offers an incentive program to encourage prenatal care. Please see Section 14 for details.
Healthy Mom/Healthy Baby provides care management and outreach services for all obstetrical patients. The program is designed to improve outcomes for mothers and newborns, with an emphasis on member outreach and education and links the member and her family with appropriate providers and community resources to ensure that she receives needed services and to identify any obstacles to care. The Obstetric Care Management staff proactively contacts identified members to perform initial and ongoing comprehensive risk assessments, to encourage early and continuous prenatal care, to develop a prenatal plan of care and to coordinate that care, to encourage and/or provide HIV testing and counseling with clinical recommendation, and to coordinate postpartum and newborn care. The standard of care for Healthy Mom/Healthy Baby follows the New York State Law 85.40, PCAP Guidelines.
Specific program components include:
- Identifying pregnant members
- Assessment of members to identify ―high-risk pregnant members
- Providing community outreach services through affiliated hospitals and clinics
- Educating patients by telephone and through literature mailed out to members
- Assessing pregnant patients for risk factors and complications
- Coordinating care in collaboration with the member’s obstetrical provider for high-risk pregnancies
You can reach this OB Care Management program by calling 1-866-463-6743.
Healthfirst offers the Healthbuddy to members that are diagnosed with Asthma, Diabetes or Congestive Heart Failure (CHF). Members who consent receive an American Medical Alert Corp (AMAC) appliance customized for their disease and allows Healthfirst Care Managers to remotely monitor symptoms, behavior and overall health status, allowing early detection of high-risk members and proactive intervention to deter adverse events. The appliance is powered by the Health Hero® platform and sends health questions and daily reminders about the members condition.
Members and their families who would like to be part of the Healthbuddy programs, please contact the Medical Management at 1-866- 463-6743.