CLINICAL SERVICES INTEGRATION
Our health, like each of us, is complex. Lots of different factors make up our over-all well being. That’s why health care involves so many specialties and sub-specialties. It’s sometimes called the healthcare continuum.
HNE’s innovative Clinical Service Integration (CSI) program brings together Behavioral Health, Case and Disease Management and Pharmacy Services. It provides our members continuity of care along the heath care continuum.
Care and Disease Management
Care and Disease Management are services designed to help our members improve their overall health. Some members will only need help for a specific disease state. Other members benefit from coordination of multiple health care issues.
Our registered nurses and service coordinators work together to support and coordinate the member’s health care. Our nurses assess the member’s health status and set up a plan to promote self management of each health condition. Making sure our members have access to the right care we ensure that our members have access to high quality and affordable care.
Through regular telephone contact, our nurses help members identify and overcome barriers they may encounter to the physician’s plan of care. They encourage members to be actively involved in care and treatment.
Through Care Management, we can:
- Help members get the care and services they need, including inpatient services,
outpatient specialty care, proper medical equipment, and pharmacy services.
- Educate members, their families and care givers about medical conditions that affect overall health.
- Monitor the member’s condition and treatment plan and assess compliance on an ongoing basis.
- Support and encourage the doctor - patient relationship.
- Encourage the member to participate in his/her own care.
Behavioral Health
Our BH Specialists help providers and members with referral information – supporting access to behavioral health services. The BH Specialists review requests for mental health and substance abuse placement and outpatient service. In support of ongoing treatment compliance, they arrange aftercare treatment.
Through Care Management, we can:
- Help set-up behavioral health care to ensure our members reach their maximum level of function.
Pharmacy
Our pharmacy team, in partnership with our Pharmacy Benefits Manager, reviews our formulary to ensure that our members have affordable access to appropriate treatments.
The pharmacy coordinators and the department’s clinical pharmacist work together to ensure appropriate drug management and to recommend generic alternatives to reduce the amount a member pays.
Through Care Management, we can:
- Coordinate your medication regime.
- Assist in managing costs associated with medications.
Health Programs
Our Health Programs Department is committed to improving the health and well-being of our community. At home, at the work site, or in the community – we offer something for everyone.
We’ve developed programs that promote preventive care and overall wellness for children and adults. We provide a variety of
health education workshops that can be conducted at the work site along with an
array of health screenings.
The Health Programs Team customizes workshops and screenings based on specific needs identified by the employer group.
We also sponsor health and wellness events in the community. Our Health Programs staff is on hand to provide screenings, advice, and educational material.
Through Care Management, we can:
- Help members become educated health care consumers capable of making
informed decisions to promote a healthy lifestyle.
- Identify community resources available to members, their families and care givers
and, when needed, assist with the referral process for these resources.
Who is a candidate for
Care Management?
Any member of Health New England can be a candidate for Care Management.
A member may be identified by:
- Complicated illness or multiple health risks factors.
- Physician referral.
- Referral following an inpatient hospital stay.
- Medical and Pharmacy claims.
- Member request.
Members can be referred by contacting HNE at:
800-842-4464 or 413-787-4000
