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The Population Health program provides a cohesive plan of action that manages the overall health of high-risk members by providing oversight to their health outcomes. Members interested in enrollment in any of the population health programs should first work with their Primary Care Physician (PCP) to obtain a referral. If the Members want to self-refer after speaking to their PCP, they can contact our Case Management team at 1-855-337-6868.
Disease Management Services
Ultimate Health Plans (UHP) now offers four Disease Management programs to eligible members with:
- Heart Failure (HF)
- Cardiovascular Disease (CVD)
- Diabetes
- Chronic Lung Disorders
A member can be referred to this program through health services programs within UHP, member or caregiver, physician, and data mining: claims, pharmacy, or laboratory results. This service provides coordinated health care interventions, education, and frequent communications with an assigned Nurse Case Manager for members with conditions where self-care efforts can be implemented. Disease management empowers members, working with other health care providers to manage their disease and prevent complications.
Complex Case Management Services
UHP continues to offer a Complex Case Management program to eligible members experiencing a catastrophic event or multiple chronic conditions that have had an adverse event causing immediate medical attention. A member can be referred to the program from the health information line, DM program, hospital discharge plan, medical management, member or caregiver, and/or practitioner.
This program provides coordinated health care interventions, education, and frequent communications with an assigned Nurse Case Manager for members with conditions where self-management efforts can be implemented.
Transition of Care (TOC)
Transition of Care occurs when a member moves from one health care provider or setting to another; for example, a member was admitted to a hospital and discharged to home, acute rehab, or skilled nursing facility. TOC services entail:
- Achieving a seamless transition upon discharge through collaboration and connect the member to appropriate providers.
- Discharge the beneficiary to the appropriate level of care.
- Serve as a resource for the beneficiary during the care transition.
- Facilitate appropriate authorizations for needed follow up care and services.
- Provide care coordination and outreach support, ensuring that the member complies with the plan of care.
Special Needs Plan (SNP)
Special Needs Plans are specialized Medicare Advantage plans for beneficiaries with severe or chronic conditions. UHP offers Chronic SNP (C-SNP) plans for members with severe or disabling chronic conditions. It is an evidence-based Special Needs Plan serving UHP Medicare members with a diagnosis of:
- Congestive Heart Failure (CHF)
- Cardiovascular Disorders (such as cardiac arrhythmias, CAD, PVD, DVT)
- Diabetes Mellitus (DM)
- Chronic Lung Disorders (CLD) such as Asthma, Chronic Bronchitis, Emphysema, Pulmonary Fibrosis, and Pulmonary Hypertension
Members can enroll year-round and receive annual assessments, individualized care plans, and case management services. Additional benefits are offered in the SNP program, including transportation, meal delivery, and assistance with filling medications.
Chronic Kidney Disease (CKD) Stage IV and V
Ultimate Health Plans maintains a program to help members who have Chronic Kidney Disease (CKD) stage IV & V manage their illness. Case Managers may assist members by coordinating blood work, helping find a nephrologist (kidney doctor) and coordinating a dietician to educate the member on this progressive disease. The stage of kidney failure is determined by a blood test (eGFR).
Members with an eGFR between 15 and 30 are considered to have a Stage IV CKD. In this case, kidneys are moderately or severely damaged and are not working as they should.
Members with an eGFR less than 15 are considered to have a Stage V CKD. In this case, kidneys are getting very close to failure or have completely failed. If kidneys fail, dialysis may be needed. Our goal is to be your partner and help you develop an individualized treatment plan that meets your needs.