Medica Administrative Manual > Health Management and Quality Improvement > Care Management > Adult Complex Case Management Program
Adult Complex Case Management Program
Case managers are available to support members living with serious or complex health conditions who are in need of services and support to manage their health. Case Managers partner with members and their providers to help manage their conditions with the goal of influencing illness trajectory, promoting adherence to the prescribed plan of care, and improving health outcomes. A personalized care plan is created based on the member’s health goals and case managers provide ongoing management and support as the member works toward those goals.
Interventions are customized based on individual need and are focused on helping members achieve their stated health outcomes. Frequent interventions include:
- Educating the member on their disease trajectory.
- Reviewing risk and benefits of treatment decisions.
- Helping to support and clarify goals of care.
- Completion of a comprehensive medication review.
- Fostering healthy patient/provider relationships.
- Identifying and resolving barriers to care.
- Assisting with community resources to address social determinates of health that may impede desired health outcomes.
For more information about Adult Complex Case Management, please call Medica Case Management at 1 (866) 905-7430 or
email us.
REV 1/2024