Care management

Regence care management supports the unique needs of members with acute, chronic and major illness episodes or severe illness conditions. The mission of care management is to prioritize the needs of our members by providing personalized, equitable services that enhance their wellbeing.

We offer a single-nurse model dedicated to delivering personalized and holistic medical and behavioral health support to each member and their family. Case managers are experienced registered nurses and social workers. Our case managers work closely with providers to help our members improve their health and meet the goals of their providers' treatment plans.

Care management goals include:

• Advocating for members and their support systems
• Improving care through close collaboration with providers
• Supporting members transitioning to different levels of care
• Assisting members as they navigate the health care system
• Educating members about their care options, benefits and coverage
• Ensuring full compliance with national quality standards, including those established by NCQA
• Supplementing information given by providers to help members make educated decisions regarding their health care
• Improving members' clinical, functional, emotional and psychosocial status by supporting their health and wellness needs, as well as their independence

• Collaborating with behavioral health providers to meet the needs of patients with chronic illness or comorbid conditions, such as chemical dependency and depression

Providers can contact our Care Management Intake Team to refer members to care management. Members can also self-refer to our program. In addition, we proactively identify and outreach to those members most likely to benefit from additional support, education and collaboration with providers.

Once a member is identified, the designated case manager calls the member. We attempt at least three calls before sending a letter to the member. The member can respond to the letter if they wish to engage with a case manager. Providers are sent a letter or contacted by phone when their patient is enrolled in care management.

Condition Manager powered by Regence is available as an optional buy up program specifically for our administrative services only (ASO) groups. The program offers clinical and educational support for members managing the following chronic conditions, including any comorbidities:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Heart failure (HF)
• Coronary artery disease (CAD)

• Diabetes

All participating members will receive educational materials. Members engaged with the Journi care team will have access to online support tools and additional resources.

Journi will work with providers to discuss their patients’ treatment plans, care gaps, medications and health goals, when appropriate. The outreach to providers will be by:

• Phone: When contacting providers, Journi Care Guides will identify that they are calling on behalf of Regence.

• Mail: Care Needs letters will be sent to providers whose patients haven't seen them in the past 12 months.

• Call 1 (866) 543-5765
• Complete a Care Management Referral Request Form