Care Management

One of NEQCA’s most successful models for managing medical utilization while improving quality is the Care Alliance Integrated Care Management model.  The program focuses on patients enrolled in Medicare Advantage.

Key components of this model include care for complex patients, referral management, and frequent physician and team meetings to monitor and improve quality of care.

Through this model, patient care is focused on four levels:

  1. Complex Care Management, provides in-home health coaching to the top 3%–5% of the highest-risk patients and coordinates care with the patients’ multidisciplinary healthcare team.
  2. Chronic Care Management for the next 15%–17% of highest-risk patients, is staffed by nurse care managers who provide telephonic coaching, management of admissions and transitions of care.
  3. Specialized Primary and Network Care in Heart Failure (SPAN-CHF), developed by Tufts Medical Center cardiologists through research interventions and implemented with NEQCA nurses, this program is for patients with congestive heart failure who require individualized assessment and education plans by providing in home monitoring of patients using telehealth technology.
  4. Case management embedded at the practice level; Care managers, facilitate the care management needs of members at highest risk for experiencing adverse outcomes in inpatient settings including hospitals, skilled nursing facilities and acute rehabilitation centers.