The Alliance Case and Disease Management (CMDM) Program is available to help you care for your complex patients and is provided at no cost to your patients.

The program coordinates services and provides support to help improve patient outcomes and overall member satisfaction.

The CMDM Team Includes

  • Health Navigators
  • Registered Nurses
  • Social Workers
  • Other team members may include: medical directors, pharmacists, and mental health professionals

How to Enroll

Care Coordination

Alliance health navigators, nurses, and social workers can provide short-term assistance if your patients need:

  • Help finding community resources.
  • Help finding providers in the Alliance network.
  • Help with illness self-management.
  • Support coordinating among multiple health care providers.

Referrals

  • Work with your patient to see if they qualify for this program. You can refer your patients by completing the Alliance Case Management Programs Referral Form.
  • The Alliance may contact the member to see if they would like to enroll.
  • Members may also self-refer.
    You can advise your patient to call:

Community Based Adult Services (CBAS)

Community-Based Adult Services (CBAS) is an outpatient, facility-based service program that delivers skilled nursing care, social services, therapies, personal care, family/caregiver training and support, meals and transportation to Alliance members. The Alliance authorizes CBAS based on a referral from the member’s PCP and an eligibility assessment completed by a CBAS provider.

CBAS Criteria

Alliance members who reside in an intermediate care facility/developmentally disabled-habilitative (ICF/DD-H) facility that provides 24-hour personal care, habilitation, developmental and supportive health services are qualified for CBAS services.

All other Alliance members must meet all of the following medical necessity criteria to qualify for CBAS:

  • 18 years of age and older.
  • A high potential for the member’s medical, cognitive, or mental health condition(s) to deteriorate or result in an emergency department (ED) visit, hospitalization, or other institutionalization if CBAS services are not provided.
  • The member has one (1) or more chronic or post-acute medical, cognitive or mental health condition(s) that requires monitoring, treatment or intervention to prevent deterioration, ED visits, hospitalizations, or other institutionalization.
  • The member’s medical condition(s) require all core CBAS services performed on each day of attendance to allow the member to remain in the community and avoid ED visits, hospitalizations, or other institutionalization.

Core Services Include:

  • Meal service
  • Personal care services/social services
  • Professional nursing services (which includes observation, assessment, and monitoring of member’s health status and medications; communication with member’s healthcare providers regarding changes in health status; supervision of personal care services; and/or skilled nursing care and intervention)
  • Therapeutic activities

The member’s non-CBAS center support network insufficient to maintain the individual in the community, as demonstrated by at least one (1) of the following:

  • The member has family or caregivers available, but those individuals require respite in order to continue providing sufficient and necessary care or supervision to the member.
  • The member lives alone and has no family or caregivers available to provide sufficient and necessary care or supervision.
  • The member resides with one (1) or more related or unrelated individuals, but they are unwilling or unable to provide sufficient and necessary care or supervision to the member.

Referrals

Work with your patient to see if they qualify for CBAS. To refer your member, please complete the Alliance CBAS Referral Form.

After we receive your referral, a nurse will interview the Alliance member to see if they are eligible for CBAS.

Complex Case Management (CCM)

The Alliance Complex Case Management (CCM) Program works collaboratively with our network of providers and members to optimize member benefits and health. This program is designed for members who have complex health needs and at risk for frequent use of emergency department services. If an Alliance member qualifies for this program, a nurse will reach out to the member to complete a comprehensive assessment.

Our team of nurses, social workers, and health navigators can help Alliance members:

  • Connect to community and social services.
  • Coordinate home-based services and durable medical equipment (DME), supplies, and devices.
  • Coordinate multiple physical and mental health care appointments.
  • Provide disease management and self-management support.
  • Reach health-related goals that the provider and member identify.
  • Understand medication adherence and safety.

This program also offers individualized care plans. Our care management team works collaboratively with the provider and member to complete comprehensive care plans. The assigned Alliance case manager will contact the provider’s office for input.

The final care plans are shared with the provider’s office. Please let us know how you would like to receive the care plans.

Referrals

  • Please work with your patient to find out if they qualify for this program. You can refer your patients by completing the Alliance Case Management Programs Referral Form.
  • The Alliance may contact the member to see if members would like to enroll.
  • Members may also self-refer.
    You can advise your patient to call:

Disease Management

The Alliance Disease Management Program currently provides services to children (5 – 11 years of age) with asthma, and adults with diabetes. These programs are designed to help empower members better manage their condition and live healthier.

Referrals

  • Please work with your patient to find out if they qualify for this program. You can refer your patients by completing the Alliance Case Management Programs Referral Form.
  • The Alliance may contact the member to see if members would like to enroll.
  • Members may also self-refer.
    You can advise your patient to call:

Health Information Form/Member Evaluation Tool (HIF/MET)

The Health Information Form/Member Evaluation Tool (HIF-MET) is a survey that Alliance members fill out.

Why is it important?

  • This tool helps members share their health concerns with their doctor. It also helps us learn what other services they may need to stay healthy.
  • The California Department of Health Care Services (DHCS) requires the Alliance to send a HIF-MET to all new Alliance members. The tool helps identify Alliance members who may need expedited services. HIF/MET aims to identify serious health concerns that should be quickly addressed.
  • Completed HIF/METs are faxed to assigned provider offices. Please review the forms as it may include helpful information that can direct their care and be incorporated into your new patient’s Initial Health Assessment (IHA).

健康風險評估

健康風險評估 (HRA) 是老年人或殘疾人每年填寫的調查。

為什麼它很重要?

此工具可幫助我們的會員與他們的醫生分享他們的健康問題。 它還有助於我們了解他們可能需要哪些其他服務來保持健康。

加州醫療保健服務部 (DHCS) 要求聯盟每年向符合 SPD 資格的所有成員發送 HRA。 HRA 可幫助識別可能需要快速服務的聯盟成員。 《人權法》旨在查明應迅速解決的嚴重健康問題。 評估也是聯盟為成員制定護理計劃的指南。

HRA 調查問卷可以由成員填寫,也可以由聯盟案例管理人員填寫(如果需要説明)。 經過審查,聯盟制定了一個個人化的護理計劃。 當成員沒有完成他們的問卷時,將創建一個標準化的護理計劃,其中包括有關健康和健康的提示。

護理計劃分批傳真或郵寄至供應商辦公室。 請在看患者之前查看護理計劃,因為它們可能包含有助於指導其護理的資訊。

我們歡迎您對如何將 HRA 納入您的護理計劃的任何反饋。