Anthem Care Management Programs are designed to simplify and improve the healthcare experience for our members. Our dedicated care managers act as guides, offering valuable health education, clarifying available services, and empowering individuals to actively participate in their healthcare journey.
Your patients may already be benefiting from the support of our care managers. If they are not connected with a care manager, or need assistance in reaching them, please direct them to call Member Services for prompt assistance. As healthcare providers, you also have the option to directly refer your patients to our comprehensive care management program, ensuring they receive the targeted support they need.
When Might an Anthem Care Manager Reach Out to Your Patients?
Anthem care managers proactively engage with members under various circumstances, ensuring timely and relevant support. They may initiate contact if:
- Either you, as their trusted healthcare provider, or our internal assessments identify care management as a beneficial resource for the member’s health needs.
- A member has recently been discharged from a hospital and requires coordinated follow-up care, including scheduling appointments with specialists or other healthcare providers.
- Frequent emergency room visits for non-urgent health concerns suggest an opportunity for better management through consistent primary care.
- Following a call to our 24/7 Nurse Help Line, a member requires ongoing support and guidance for their health issues.
- Members are managing complex physical health conditions that necessitate enhanced support and coordination of care.
- Individuals are facing behavioral health challenges and need assistance in navigating and integrating care from multiple healthcare professionals.
How Anthem Care Managers Provide Essential Support:
Our care managers offer a range of services aimed at streamlining healthcare access and improving patient outcomes. They are equipped to assist with:
- Coordinating and arranging necessary healthcare services, ensuring seamless access to the care members require.
- Facilitating referrals to specialists and obtaining prior authorizations for procedures or treatments, reducing administrative burdens for both patients and providers.
- Regularly reviewing and monitoring a member’s plan of care, ensuring it remains aligned with their evolving health needs and goals.
Understanding Contact from Anthem Care Managers:
We understand that members may occasionally have questions or need clarification regarding calls from our care managers. To ensure transparency and trust, when an Anthem care manager contacts a member, they will always:
- Clearly identify themselves by name, professional title (Nurse or Social Worker), and their affiliation with Healthy Blue, ensuring transparency and legitimacy.
- Explain the purpose of Anthem care management programs and detail the specific services available to support the member’s health and well-being.
- Engage in a comprehensive conversation about the member’s health status, lifestyle factors, and overall well-being to tailor support and resources effectively.
