Clinical Programs: Condition Management and Care Management
Our Medicare Advantage plans provide a full spectrum of care management programs as part of our standard plan offerings. Clinical programs include inpatient care management, care and condition management, specialty care management (e.g., transplant and end stage renal disease (ESRD) management), behavioral health care management, HouseCalls, and Advanced Illness. Participation by the member is encouraged, but voluntary.
Condition management programs
UnitedHealthcare condition management programs are designed to help members with chronic conditions, such as diabetes, heart failure, and end stage renal disease (ESRD), to be their healthiest. UnitedHealthcare offers education and resources to support optimal health of members who are currently being treated for chronic conditions. Members receive case management and can attend workshops to engage members in managing their condition.
Care management programs
Inpatient Care Management
Nurses review the clinical information that outlines the clinical treatment plan for the member and evaluate appropriateness for admission based on evidence-based medicine and discharge planning needs, including identification of members for post-discharge follow-up and referral to outpatient programs.
Behavioral Health
Led by experienced geriatric psychiatrists and licensed behavioral health clinicians, our program integrates with our medical team to identify, engage and manage members' behavioral health concerns.
Community Transitions Program
Designed to reduce complications by smoothing the transition from hospital to home, program staff coordinate transitions in care or changes in member health status to avoid potential adverse outcomes and unnecessary readmissions.
High Risk Care Management
Nurses support members who have complex care needs by helping them access care, coordinate services and understand how to better manage their chronic conditions.
Advanced Illness
Provides comprehensive care for members facing life-limiting illness generally defined as the last 12 months of life.
Transplant Resources
Our transplant management program drives positive clinical outcomes by addressing the complex needs of members who are facing transplants.
Post-Acute Transition Program
Uses an individualized, whole-person approach to remove barriers to discharge from post-acute care, such as skilled nursing facilities (SNF) so the member can safely return to the least restrictive setting possible.