MercyCare Health Plans uses a population health management (PHM) program to focus on keeping members healthy, health and wellness education, patient safety, outcomes across healthcare settings, and complex case management.
Our programs identify members through capture and review of laboratory values, diagnosis codes received on medical and behavioral health claims, pharmacy data, registry data (i.e. Wisconsin Immunization Registry), referrals from utilization management nurses, customer service reps, or quality improvement staff, and data from Mercyhealth System’s EHR system. The reports to identify members are no more than 10 seconds behind real time events. Members become eligible for PHM services once they are identified by the reporting system. Members can also request a referral for assessment of eligibility for PHM services by calling customer service e-mailing the Quality Improvement Team at firstname.lastname@example.org.
Customer service can be reached at the number on the back of your insurance card.
Keeping Members Healthy
Childhood Immunizations – We contact parents of children younger than two years of age who are not up to date with combo 10 immunizations according to Centers for Disease Control (CDC) Guidelines. Staff connects parents to appropriate clinic staff to facilitate scheduling of appropriate immunizations.
Preventive Screenings – We contact all adult members who are missing two or more regular preventive screenings. Staff connects members with a PCP when needed. Otherwise staff connects members to appropriate clinic staff to facilitate scheduling/ordering of appropriate screenings.
Health and Wellness Education
MercyCare Health Plans has a health and wellness educator, available to members with certain chronic conditions. They’re dedicated to improving your health and helping you reach your health, wellness, and lifestyle goals. Some of the ways we do this include:
- Help set goals to better manage chronic disease
- Help you overcome difficulties that prevent you from meeting your health goals
- Help with questions about chronic diseases and related complications
- Help you understand your medical benefits
- Work with your doctor(s) to help coordinate care
- Help you use technology to manage your health
- Help you find community services to improve your health
To learn more about an available program, click on the program title.
MercyCare Health Plans requires doctors to use safe opioid prescribing practices. Our opioid monitoring program emphasizes patient safety and safe provider practices. This program is overseen by the Pharmacy Director.
Outcomes across Healthcare Settings
MercyCare Health Plans runs a specialized behavioral health utilization management program to ensure members with behavioral health needs receive the best coordinated care across multiple healthcare settings.
Complex Case Management
MercyCare Health Plans complex case management program is a collaborative process of assessment, planning, facilitation and advocacy for options and services that meet your health needs. We offer members open communication and resources to promote cost effective outcomes.
The case manager nurse evaluates criteria such as diagnosis, complications, cost, current status, prognosis, and situational and functional analysis to identify potential members suitable for effective case management intervention.
If you would like to be assessed for this service, please call (800) 895-2421.
**Members can call at any time to opt-out of the above programs.