Case and Disease Management
Coordinated Support For Your Patient
Members with complex health needs may require additional support, resources, and coordination to effectively manage their conditions and prevent complications. MHS Care Management programs work alongside providers to support treatment plans, assist with care coordination, and help members access needed services.
Referrals
To refer a member to Care Management or Disease Management, providers may utilize the MHS Secure Provider Portal, contact MHS directly at 1-877-647-4848, or send a secure message.
Who Qualifies for Care Management?
Care Management provides additional support for members who need assistance accessing care, coordinating services, or managing chronic conditions. Services are individualized and focus on improving access, closing care gaps, and supporting preventive care. Your patient may benefit from Care Management if:
- They have been diagnosed with a serious medical condition
- They have multiple injuries or medical problems
- They may be at risk for a future adverse health event due to an existing medical condition
- They are undergoing an extended hospital stay
- They are seeing several doctors
- They have had recurring re-admissions for a single diagnosis
- They may need an organ transplant
- Their condition renders them incapable of performing daily independent living activities
Complex Care Management
MHS members are automatically enrolled in our complex case management program after they are identified with a qualifying condition. Eligibility is based on diagnosis and medical services. Membership is voluntary and members have the option to end participation at any time.
Complex Care Management is available for members meeting the following criteria:
- Transplants
- Multiple chronic illnesses with high utilization
- Catastrophic conditions/special needs requiring coordination of care
- Special needs populations, as defined by the State, which are not already covered in an MHS Disease Management program
Who Qualifies for Disease Management?
The following disease management programs are available to MHS members:
- Asthma
- Adult Diabetes
- High-risk Pregnancy
- Substance abuse
- Perinatal Depression
- Depression
- Attention Deficit Hyperactivity Disorder (ADHD)
- Chronic Obstructive Pulmonary Disease (COPD)
- Congestive Heart Failure (CHF)
- Coronary Artery Disease (CAD)
- Chronic Kidney Disease (CKD)
Health Condition Management
The following Health Condition Management programs are also available to MHS members:
- Asthma
- Diabetes
- Depression*
- Pediatric Asthma
- Pediatric Diabetes
- Perinatal Depression
- Attention Deficit Hyperactivity Disorder (ADHD)
- Chronic Obstructive Pulmonary Disease (COPD)
- Congestive Heart Failure (CHF)
- Coronary Artery Disease (CAD)
- Chronic Kidney Disease (CKD)
*Depression management services are delivered based on referral from existing clinical management programs relative to member need and program eligibility.
MHS Care Manager’s Role
MHS Care Managers are licensed clinical professionals, including registered nurses and social workers, who partner with you and your patient to support the overall plan of care. They work collaboratively to develop and coordinate care plans that address the full range of medical, behavioral, and social needs.
Care Managers help identify available services, connect patients to appropriate resources, and support access to covered benefits. They also assist in addressing barriers such as housing, food, and transportation that may impact a patient’s ability to follow the treatment plan.
Acting as a central point of coordination, Care Managers collaborate with providers, patients, and care teams to ensure services are aligned and care is delivered effectively.
MHS Health Library
MHS Health Library provides easy access to reliable, up‑to‑date health education materials that support patient care and reinforce your treatment plan. Providers can use the library to print and share condition‑specific information sheets that help patients better understand their diagnosis, manage their health, and follow recommended care. These resources are designed to promote patient engagement, improve self‑management, and support better health outcomes.