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Case and Disease Management

Recovery is Our Top Priority

Your patient’s recovery is our top priority. Members with complex medical needs often require a wide variety of resources and specialized information to help manage their health, prevent complications and improve their quality of life. Our programs can help you help your patient by supporting your treatment plan and assist your patient in getting the services you order.

Referrals

To refer a member, please complete the Care/Case/Disease Management Request form, available on our Provider Forms page. For more information, please call MHS Case/Disease Management at 1-877-647-4848 or send us a message.

Who Qualifies for Case Management?

Your patients may benefit from Case 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 Case 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 Case 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
  • ADHD
  • COPD
  • CHF
  • CAD
  • 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
  • Depression*
  • ADHD
  • COPD
  • CHF
  • CAD
  • 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 Case Managers are trained professionals – registered nurses and social workers. The Case Manager will work with the patient to develop a care plan for the complex array of services that your treatment plan requires. The Case Manager can assist in identifying the services available and providing options to maximize covered benefits. We will also help your patient to address issues such as housing, food and transportation.

The Case Manager knows what questions to ask, where to find answers to questions and how the pieces fit together. Generally, the Case Manager contacts the patient and treatment team by phone and in writing, but the Case Manager can also arrange to visit the patient at home or at the hospital. Case Managers are available by phone during business hours, and have a voicemail box available after hours.

MHS Health Library

You can print health info sheets from MHS’ Health Library to give to your MHS member patients.