Care Management

Martin’s Point offers the following care management activities:

Chronic Care Management: Members work with a nurse care manager to better understand their chronic conditions, ensure coordination with community providers, adhere to treatment plans, manage medications, improve self-management skills, and take proactive steps towards feeling better.

Transitions of Care: Members work with a care manager to follow up after transition to home, complete medication reconciliation, provide education, review treatment plans, and coordinate follow-up care with community providers.

Behavioral Health: Members work with a social work care manager to assist with both transitions to home and longer term support, review treatment plans, provide education, manage medications, improve self-management skills, and take proactive steps toward feeling better.

Maternity: Members work with a nurse care manager to receive maternal health support and education during and after pregnancy to promote the best opportunity for positive health outcomes for both mothers and newborns.

To refer a member to a care manager at Martin’s Point by visiting our Forms and Documents page or call 1-877-659-2403

Health Management Communications and Resources

24/7 Nurse Advice Line

Health Plan members enjoy 24/7 access to trained nurses who can answer their health questions. This service is provided by CareNet in partnership with Martin’s Point. Members can call anytime with questions about symptoms, injuries, or illness. US Family Health Plan members can call 1-800-574-8494. Generations Advantage members can call 1-800-530-1021.

Healthwise Knowledgebase

Healthwise Knowledgebase is an online resource that offers comprehensive health information to help our members make decisions about their health. Providers and members can access this resource here.

View Prior Authorization Guidelines

Clinical Guidelines

At Martin’s Point our utilization reviewers adhere to clinical guidelines that are based on scientific evidence published in peer-reviewed medical literature that is recognized by the medical community. This ensures that our members receive consistent, high-quality care while avoiding inappropriate or unnecessary procedures, services, and expense. There are no incentives (financial or other) to deny care. Utilization reviewer decisions are based only on appropriateness of care and existence of coverage. These guidelines are reviewed annually by the Martin’s Point Health Plan Clinical Quality Management Committee (HPCQMC). Guidelines, processes, and updates are also communicated to providers regularly through our Provider Manual and newsletter, The Point. If you have questions or would like a paper copy of these guidelines, please call 1-866-800-8833.  

Generations Advantage Focus DC (C-SNP)

Chronic Condition Special Needs Plan Focused on Diabetes Care

MODEL OF CARE Medicare Advantage Special Needs Plans are designed to provide targeted care and services to individuals with unique needs. The Generations Advantage Focus DC plan (C-SNP) is a Chronic Condition Special Needs Plan designed for Medicare-eligible people diagnosed with diabetes as a chronic or disabling condition.

Network providers can find an overview of the plan, its Model of Care, and the benefits your patients receive on the plan at: Generations Advantage Focus DC (C-SNP) Model of Care Information For Providers