Complex Case Management Available

Humana-insured patients who are severely ill or who have experienced multiple trauma injuries that require a high level of in-hospital and post-discharge care may be eligible for Humana's new Complex Case Management program. The program, implemented in December 2002 and operated by SHPS Healthcare Services Inc., provides targeted care coordination for patients who may require more hands-on assistance with such issues as level-of-care changes, discharge planning or outpatient services coordination.

"Humana reaches out to assist members in many ways from high-touch programs to high-tech interactions, such as e-messaging and voice-activated technology messages. Even as Humana has moved to navigation and guidance of members, at times there is still a need for hands-on assistance with coordination of care," said Charlotte Moore, Humana's vice president of clinical interventions. "This program is really about facilitating services for members who have complex care needs."

Available for fully insured commercial members, the Complex Case Management program will be used during the acute phase of their illness by members who are dealing with catastrophic illness or injury, or complex health issues.

SHPS Healthcare case managers provide a range of services for members enrolled in the Complex Case Management program. Case managers educate the member and family about the member’s disease and condition. They also gather information from facilities and work proactively with discharge planners and the member's physicians to establish the discharge plan and facilitate arrangement of certain outpatient services, as needed. SHPS Healthcare provides monthly reports to Humana, outlining services provided and rationale for continued program participation.

The program also strives to provide assurance to physicians that patients who may be overwhelmed with their health circumstances are receiving assistance as they move through today’s complex health care system.

Please note that physicians cannot refer patients to the program (patients will be identified by case managers depending on their condition/diagnosis/need for post-discharge services). If physicians have patients enrolled in the program, they can contact Kathleen Ross, Humana's director of disease management and clinical interventions, at (816) 941-5473. The program is available for all commercial products, but not for administrative service only accounts.

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