Enhancements to the PCMH Care Management Process
Enhancements to the PCMH Care Management Process
We are excited to share some upcoming improvements to our Care Management referral process, designed to be simple and seamless for physicians and their staff. Effective January 2, 2024, referrals for any CareFirst member (Commercial, Maryland Medicaid, Medicare Advantage and Dual-Eligible Special Needs) may be submitted via a single direct phone line (888-264-8648) or secure email (CareManagement@carefirst.com).
While the new referral process will be available to any contracted provider, we are only formally notifying practices enrolled in our PCMH program at this time. For the past decade, primary care providers have played a unique role in helping CareFirst to identify patients with unmet needs and connect them to our care management resources. We want you and your staff to be the first to have access to our enhanced processes before communicating about them more broadly.
Here's what you can expect:
- Easy Referrals: Referrals can be made 24/7 via direct phone or secure email for any CareFirst member, regardless of insurance policy.
- Care Plan Eligibility: A Care Management Coordinator will review the referral and match members to the most appropriate suite of clinical support programs tailored to the patient’s needs.
- Timely Communication: Confirmation of Care Management will occur, usually, within 24 business hours, as well as communication from care teams through the duration of the care plan, including care plan activation, graduation, and acute event follow-ups.
- Care Management Support Team: When needed, a larger multidisciplinary team including a lead care manager, pharmacist, social worker, and behavioral health care manager can be engaged to support Social Determinants of Health (SDOH), gaps in care, pharmacy, behavioral health, and follow-up appointments with PCP and specialists.
- Patient Resources: More comprehensive care plans with access to home health, community resources, and SDOH support programs.
- Specialized Care Management: Dedicated teams focused for Oncology, High-Risk OB, Pediatrics, and HIV.
- More Time with Your Patients: Refer patients as needed without required scheduled time with care managers to review patient lists.
Our Care Management is transforming to meet a changing healthcare landscape. These enhancements will improve access and timeliness to expanded support and resources while reducing the burden to you and your office staff. Your CareFirst Practice Consultant will remain your point of contact for all other value-based care matters.
We are excited to implement these enhancements as we approach 2024. Please be on the lookout for future communication from CareFirst.