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).

Health Risk Assessment (HRA)

The Health Risk Assessment (HRA) is a survey that seniors or persons with disabilities (SPDs) fill out each year.

Why is it important?

This tool helps our 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 annually send HRAs to all of our members who qualify as an SPD. The HRA helps identify Alliance members who may need expedited services. The HRA aims to identify serious health concerns that should be quickly addressed. The assessment is also a guide for the Alliance to create care plans for members.

HRA questionnaires can be filled out by members, or with an Alliance Case Management staff if help is requested. After review, the Alliance creates an individualized care plan. When a member does not complete their questionnaire, a standardized care plan is created, which includes tips on health and wellness.

Care plans are faxed or mailed in batches to provider offices. Please review the care plans prior to seeing your patients as they may include information that can help direct their care.

We welcome any feedback that you may have on how to incorporate the HRA into your plan of care.