Member Health Services

Care Management Programs

As a Martin’s Point Generations Advantage member, you are eligible to receive FREE, personalized care management. You can sign up for a dedicated medical or behavioral health care manager who will help you succeed at leading a healthy, active, and full life.

Care management assessments are conducted over the phone, so you won’t have to leave the comfort of your own home. And we’ll call you, so you won’t incur any long-distance charges. Your care manager will help you better understand your conditions and work with you to set small, achievable goals so you can take control of your health. We will also stay in touch with your doctor to make sure they know about the progress you’re making.

Our care management programs may help you if:

• You have complex, chronic, or multiple medical conditions
• You’ve recently had a serious injury or medical event
• You need help managing your medications
• You are in an unsafe home environment
• You are struggling with medication or health care costs
• You face social barriers, such as lack of family support, transportation, nutrition, and/or community resources.

Care Management

Navigating the health care system can be a challenging and frightening experience. Often, you may not be aware of all the resources available to you when you or a family member are hospitalized, receive a diagnosis, or begin a new medication.

Our care management team is available to help you get the care you need.

Services include, but aren’t limited to, helping you with:

• Transitioning from a hospital to home or another facility
• Understanding your medications
• Obtaining the medical equipment you need, like a wheelchair, brace, or other special equipment
• Navigating the health care system
• Finding community resources

WHAT CARE MANAGEMENT SERVICES DO WE OFFER?

• Chronic Care: A nurse care manager helps you learn about your chronic conditions and build skills to proactively manage your health. They review medications, help coordinate your care and find helpful community resources.

• Transitions of Care: A nurse or social work care manager follows up with you after you go home from a hospital or rehabilitation stay. They help with education, review your treatment plan, review your medications, and coordinate follow-up care.

• Behavioral Health: A social work care manager provides phone support from a one-time call to six months of care management. They provide support to you, your family, and/or caregivers based on your goals, and help coordinate care with providers and community resources.

• Maternity Support: A nurse care manager works with you during pregnancy and after delivery to help you know what to expect, answer questions, and provide support. They help coordinate care with providers and identify community resources. Sign up at any time during your pregnancy.

Utilization Management

Martin’s Point Health Care uses qualified licensed health professionals to assess the clinical information used to support Utilization Management (UM) decisions. UM decision making is based only on appropriateness of care and service, and the existence of coverage. The organization does not specifically reward practitioners or other individuals for issuing denials of coverage. Martin’s Point does not provide financial incentives for UM decision makers to encourage decisions that result in underutilization.

Martin’s Point care management programs are entirely voluntary. You can choose not to participate or to stop participating in the program at any time. If you have immediate concerns regarding your health, please contact your doctor. Always consult your health care provider before making any lifestyle changes. Only your doctor can diagnose and treat a medical condition.

We want to help you live the healthiest life possible. If you would like to speak with a Martin’s Point care manager, please call 1-877-659-2403.

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