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Ultimate Health Plans offers many programs to help members manage their health care needs. Members may be referred to these programs by their physician, an Ultimate Health Plans Care Manager, or a caregiver. Members may also refer themselves for enrollment in these programs. Ultimate also identifies members who could benefit from these programs or services based on diagnoses, care that the member needs but has not yet received, or certain events such as a recent hospital stay.
Once a member is identified as eligible for a Population Health Program, the member is automatically enrolled but may opt out at any time by calling Ultimate Health Plans. Members may also be disenrolled from a program when they no longer meet program criteria. If you would like additional information about these programs or to request enrollment in a program, please call Customer Service between 8 a.m. to 8 p.m. on Monday through Sunday at 1-855-858-7526 or TTY at 711.
Complex Case Management Program
Ultimate Health Plans maintains a Complex Case Management Program for members who may need short-term help after a recent hospital stay or who have more complex needs, such as when dealing with multiple chronic conditions. For example, Case Managers can help members transition home or to a skilled nursing facility after a hospital stay, or work with members who may need extra help with managing multiple medical conditions. Case Managers coordinate with members and the member's primary care provider and/ or specialists to review medications, create goals for embers to manage their own health, provide disease or condition-specific education, and assist with making appointments.
Care Managers may also help members address other challenges that prevent them from maintaining their health by arranging for transportation or making referrals for financial assistance.
Disease Management:
Ultimate Health Plans offers several Disease Management Programs to help members who have been diagnosed with any of the following conditions:
- Heart Failure
- Cardiovascular Disease
- Diabetes
- Chronic Lung Disorders
Members enrolled in these programs receive help with managing their conditions. Program services include providing condition-specific education, setting goals and monitoring progress, help making medical appointments, and providing referrals to available community programs and services.
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.
Preventive Care and Chronic Condition Management Initiatives:
Ultimate Health Plans identifies members who may benefit from certain preventive services, such as flu shots, colonoscopies, and mammograms, as well as other care to help members manage their chronic conditions, such as diabetic eye exams. Ultimate may notify eligible members about care for which the member is due but has not yet received, and help the member get the needed care.
Some examples include notifying members about flu shot clinics, help scheduling colonoscopies, arranging for transportation to a facility for a mammogram, or calling or mailing members to remind them that they are overdue for a diabetic eye exam.