Complex Case Management

Complex Case Management is intended to empower members to take control of their health care needs across the care continuum by coordinating quality health care services and the optimization of benefits through a realistic, cost-effective, and timely case management plan. By collaborating with members and their care team, complex case managers are able to facilitate access to health care services and provide support for health-related decisions, which may allow members to obtain the highest quality of care, maximize their health care coverage, and potentially save money. The DHMP complex case management program targets high utilizers and high cost members to help them better manage their health.

Members enrolled in the complex case management program will have a thorough initial assessment that captures current health status, condition specific issues, clinical history, comorbidities, behavioral health status, activities of daily living, psychosocial issues, and life planning issues. An evaluation of cultural and linguistic needs, visual and hearing needs, and caregiver involvement are also assessed. A detailed case management plan including prioritized goals and self-management goals are communicated with the member along with a follow-up schedule for next appointments.

For members within the Commercial Highpoint and Medicare Advantage plans, this is a no-cost program to the member. If you would like to refer your patient to our complex case management services, please call 303-602-2184 for more information.