AvMed’s Care Management Programs

Disease Management Programs

Our programs help you manage your chronic health conditions for a longer, healthier, and more active life. Each program is designed for your individual health needs and it is available at no extra cost to you! A care team led by a registered nurse will work with you and your doctor to help you better manage your condition. AvMed offers disease management programs in the following areas:

Case Management Programs

When members face complex or life threatening conditions, our medical management philosophy is to offer them access to high-tech care and high-touch service that is coordinated to ease their concerns. Programs are administered by registered nurses and technicians and supported by AvMed medical directors.

Chronic Kidney Disease:
The CKD program is designed to identify members at risk for chronic kidney disease. The focus of the program is early identification and treatment so that disease progression can be delayed or prevented. The program is based on The National Kidney Foundation Guidelines, and registered nurses work closely with nephrologists to educate and support members statewide. Many materials from the National Kidney foundation are available.

Wound Care:
The Wound Care Program focuses on our members with chronic, complex and poorly healing wounds. The wound care coordinator works with our wound care provider network to coordinate services and strategies to address complex wounds. The nurse provides ongoing telephonic support, coordination, and monitoring.

Complex Case Management

Specialty Care Programs

Specialty care at AvMed focuses on high risk obstetrics, oncology and transplant. Registered nurses in these specialties assist and work closely with members and their medical team to provide the best possible outcomes.

Healthy Expectations:
The Healthy Expectations Program focuses on pregnant members and those members experiencing high-risk pregnancies. All pregnant members receive a complimentary educational packet that provides tips and guidance during all stages of the pregnancy. A pregnancy survey included in the packet should be filled out and returned to the Healthy Expectations program for enrollment. Pregnant members should call Member Services at (800) 882-8633 to receive the educational package.

Members identified by their obstetrician as high-risk will be assigned a maternity nurse Care Coordinator who will provide health surveys, counseling, and coordination of services throughout the member’s pregnancy and post partum period. Members who have been identified as high-risk can also self-refer themselves to the Healthy Expectations program by calling AvMed Member Services. All counseling and educational activities are customized to the member’s high-risk condition and unique pregnancy needs.

Oncology:
The oncology care management program provides individualized attention to oncology patients with a variety of cancers. The goal of the program is to work collaboratively with providers, provider’s staffs and support systems within communities, utilizing standards set by the National Comprehensive Cancer Network. The program follows our members from initial diagnosis, assuring treatment and beyond treatment to ensure continuity with a professional registered nurse specializing in oncology. Our approach is holistic, providing sensitive and caring support while implementing knowledge and professionalism in the field of cancer care. Our oncology management program also has experience and professional affiliations with the Oncology Nurses Society, which allows for the dissemination of the most up-to-date cancer care information to its members in an effort to inform and empower the member. The oncology care manager communicates with providers as an advocate for its members and family support systems to improve quality and enhance life.

Transplant:
The Transplant Care Management Program is a statewide resource for both members and providers to assist with identifying, facilitating, and coordinating transplant services with an appropriate Transplant center. All members referred for transplant consideration are enrolled in this program as soon as they are identified. Transplant benefits are determined and contracting issues are addressed. This program provides medical review and authorizations for services, and assistance with claims issues is given as needed. Enrollment in this program continues as long as the member is being considered for transplant, throughout the transplant process until the member is successfully transplanted and stable (usually 1 year after transplant), and requiring no further specific interventions.

Last modified March 31, 2008