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 for Population Health Management Programs and QI Initiatives
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 QI initiatives and wellness programs are based on evidence-based clinical practice guidelines as outlined below:
| Diabetes |
- American Diabetes Association (ADA)
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| Hypertension |
- Joint National Committee 8 (JNC 8)
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| Asthma |
- National Heart, Lung, and Blood Institute (NHLBI)
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| Depression |
- American Psychiatric Association (APA)
- Clinical Practice Guidelines for the Management of Depression- PMC (NIH)
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| Anxiety |
- American Academy of Family Physicians (AAFP)
|
| COPD |
- National Heart, Lung, and Blood Institute (NHLBI)
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| Heart Failure |
- American College of Cardiology and American Heart Association (ACC/AHA)
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| Perinatal |
- American Academy of Pediatrics and American College of Obstetrics and Gynecology (AAP/ACOG)
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| Substance Abuse |
- American Psychiatric Association (APA)
- Treating Tobacco Use and Dependence: PHS Clinical Practice Guideline from Agency for Healthcare Research and Quality (AHRQ)
- Substance Abuse and Mental Health Services Administration (SAMHSA)
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| Wellness and Health Promotion Programs |
- US Department of Health and Human Services Office of Disease Prevention and Health Promotion
- Centers for Disease Control and Prevention (CDC)
- National Institute of Health (NIH)
|
Screening Children and Adults for Behavioral Health Needs
Group Health Cooperative of Eau Claire requires providers to use age-appropriate validated behavioral health screening and assessment tools to identify potential developmental delays, health concerns, or behavioral issues early on, allowing for timely intervention and support. This proactive approach can significantly improve a child's overall development and well-being. The following toolkits and/or clinical practice guidelines are recommended resources when providing care to our members.
General Development and Primary Care Guidelines in Children
- Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents is the national standard for well-child care. Resources relate to preventive health supervision and health screening.
- Caring for children with autism spectrum disorder.
- Caring for children with ADHD.
- Primary care guidelines for assessing, treating, and referring common behavioral problems in children.
- Primary care guidelines for assessing, treating, and referring common behavioral problems in adults.
- Resources necessary to determine appropriate diagnosis, treatment, and referral of depression and antidepressant medication management.
- Clinical practice guidelines for the appropriate treatment of tobacco use and dependence.
- Clinical practice guidelines for the appropriate treatment of alcohol abuse and other substance use disorders.
Referral Process
To refer a member for complex case management or a disease management program please contact Member Services at (888) 203-7770 (TTY 711)