GHC offers comprehensive population health management programs for members which include complex case management and disease management.  The goal of the programs is to create a collaborative relationship between the member, case management staff, the member’s providers, and community agencies to assist members with meeting their health needs.  The population health management programs are outlined below.
 

Complex Case Management

Case management is a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual’s health needs through communication and ensuring access to available resources, services, and care to promote quality, cost-effective outcomes. Complex case management’s goal is to help members regain health and improve functional capabilities. Case managers also help members manage chronic conditions including diabetes, heart failure, COPD, Asthma, General Anxiety Disorder, and Depression.

Disease Management

The program uses a member-centric, individualized, strength-based approach aimed at motivating and engaging members in understanding their condition and self-management through preventive care and behavior modification.  The goal is to reduced complications of chronic disease and improve quality of life for the member. Group Health offers the following disease management programs:

• Perinatal (pregnancy)
• Hypertension
• Substance Abuse

Clinical Practice Guidelines

Case management processes and algorithms are built upon evidence-based clinical practice guidelines. All case management processes are based on the Case Management Society of America (CMSA) standards of practice. All disease management and wellness programs are based on evidence-based clinical practice guidelines as outlined below:

Diabetes	American Diabetes Association
Hypertension	Joint National Committee 8 (JNC 8)
Asthma	National Heart, Lung, and Blood Institute (NHLBI)
COPD	National Heart, Lung, and Blood Institute (NHLBI)
Heart Failure	American College of Cardiology and American Heart Association (ACC/AHA)
Perinatal	American Academy of Pediatrics and American College of Obstetrics and Gynecology (AAP/ACOG
Substance Abuse	American Psychiatric Association (APA)
Wellness	United States Department of Agriculture (USDA), US Department of Health and Human Services Office of Disease Prevention and Health Promotion
Health Promotion program (Incentive program for commercial groups)	United States Department of Agriculture (USDA), US Department of Health and Human Services Office of Disease Prevention and Health Promotion, Wellness Council of America, National Wellness Institute

To refer a member for complex case management or a disease management program please contact Member Services at (888) 203-7770 (TTY 711)