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Care Management

Care Management

"Boots on the ground"

Care Management is essential to everything we do. Care Managers ensure the continuity of care that occurs between providers, hospital, and home by:

 • Helping patients and practices manage chronic diseases according to national evidence-based treatment guidelines

• Targeting care management services to help patients avoid unnecessary emergency room visits, hospitalizations, and readmissions

• Assisting patients with hospital transition to ensure medications, services, and equipment are in place and properly utilized

• Conducting medication reconciliation to ensure prescriptions are filled and no discrepancies exist

• Linking the patient back to the medical home after a hospital discharge

• Coordinating care with the medical home and other community agencies providing supportive services

To be eligible for care management, a patient must receive Carolina Access II Medicaid or be Dually Eligible (Medicare/Medicaid), and the patient's primary care physician must be a member of a participating medical practice.

Each network practice is assigned a care manager and provides the practices with:

• Ongoing education and training

• Data analysis on utilization patterns and performance

• Continuous quality improvement initiatives

• Centralized disease management program development efforts