Case/Disease Management (Care Management)

Aetna Better Health offers an evidence-based, care management program to help our members improve their health and access the services they need. Case managers typically are nurses or social workers. These professionals create comprehensive care plans that help members meet specific health goals.

Each member has his or her own case manager. How much care management a member receives is based upon his or her individual needs. Some of the reasons you may want to ask us to have a case manager contact the member include:

  • Does the member frequently use the emergency room instead of visiting your office for ongoing issues?
  • Has the member recently had multiple hospitalizations?
  • Is the member having difficulty obtaining medical benefits ordered by providers?
  • Has the member been diagnosed with heart failure, diabetes, asthma, or chronic obstructive pulmonary disease (COPD), yet does not comply with the recommended treatment regimen?
  • Does the member need help applying for a state-based, long-term care program?
  • Does the member have HIV?
  • Is the member pregnant and designated high-risk?
  • Is the member pregnant and over 35 years of age?
  • Has the member received a referral to a specialist, but is unsure of the next steps?
  • Does the member need information on available community services and resources not covered by Medicaid (e.g., energy assistance, SNAP, housing assistance)?

After you make a referral, a care manager contacts the member. The case manager may also contact the member's caregivers or others as needed.

To help members learn how to manage their conditions and meet their individual needs, a care manager meets with each member to complete an assessment. The care manager asks the member questions about his or her health and the resources currently being used. The member's answers help the care manager determine what kind of assistance the member needs most.

Next, the member and the care manager work together to develop a care plan. The care manager also educates the member on how to obtain what they need. The carfe manager may work with the member's health care providers to coordinate care. How much assistance the member needs and how frequently the care manager sees him or her will vary based upon individual needs.

To make referrals for care management consideration, please call Provider Services at 1-855-676-5772 or 313-465-1529. A care manager will review and respond to your request.

 

 

 

The Aetna Medicaid website is a resource for members and providers regarding chronic condition management programs and interventions.  Providers can request to enroll members in integrated care management using a form found here.  Fax referral form to secured CM fax line: 866-889-7572