SearchThe Targeted Case Management Program addresses members with medical and/or behavioral health care needs who are also high-cost and/or high-utilizers of the health care system.
Often, a small percentage of the population accounts for the majority of health care use and expenditures. By having dedicated case management staff, the program is able to meet the needs of this specific population.
Primary referrals for TCM are identified from cost and utilization reports/data and claims. This includes a monthly report with a 90 day retrospective review of the top 25 unique members in following categories:
- Number of Emergency Room utilization
- Number of Unplanned Emergency Room to Hospital admissions
- High Cost Admissions
Additional referrals are received from other sources including but not limited to the Denver Health Inpatient Care Management team, Emergency Department Social Worker and/or RN Care Coordinator, primary and/or specialty care providers and/or community-based organizations (including Colorado Coalition for the Homeless).
Intervention/services include:
- A comprehensive needs assessment and periodic reassessment
- Coordination between various systems (i.e.: health care, human services, mental/behavioral health)
- Resource connection and coordination
- Patient Education
- Motivational interviewing to assess and support behavior change
- Collaborates with community organizations/systems and utilizes a ‘continuity of care’ team approach to address the complex, multi-factorial needs
- Co-management with community case managers, as appropriate
Referrals to the TCM Program can be made either through Denver Health’s Appointment Request Line (ARL) system or email a Medical Management Referral form to caresupport@dhha.org. Providers can also obtain more information and refer members by contacting us directly at (303) 602-2080 or www.denverhealthmedicalplan.org.