MercyCare Health Plans has a population health management (PHM) program to help our members live healthier lives. We focus on keeping members healthy, health and wellness education, patient safety, outcomes across healthcare settings, and complex case management.
Our programs identify members based on:
- Lab results
- Info from medical and behavioral health claims
- Pharmacy data
- Registry data (i.e. Wisconsin Immunization Registry)
- Data from Mercyhealth System’s EHR system
Members who are eligible for this program will get a call about our PHM program. If you’re a member you can ask for a free assessment for our PHM program. Please call the customer service at the number on the back of your insurance card or e-mail the Quality Improvement Team at email@example.com to request your assessment.
Keeping Members Healthy
Childhood Immunizations – We call parents of children less than two years old, who don’t have all their shots according to Centers for Disease Control (CDC) Guidelines. Getting shots on time helps keep children from getting or spreading illnesses that can be life threatening to them. Staff connects parents to clinic staff to get appointments for needed immunizations.
Preventive Screenings – We call adult members who are missing two or more preventive screenings. Preventive screenings are tests that help doctors find certain medical conditions early. These tests can help find cervical, breast, or colorectal cancers early. Finding cancer early can lead to better outcomes. Staff connects members with a primary care provider (PCP). Otherwise staff connects members to appropriate clinic staff to facilitate scheduling or ordering of screenings our members need.
Health and Wellness Educator
MercyCare Health Plans has a Health and Wellness Educator available to members with certain chronic conditions. Their role is to help you reach your health goals.
They do this by helping you:
- Set goals that progress at your pace
- Overcome barriers
- Answer questions
- Work with your providers to coordinate care
- Use technology that you are comfortable with
- Identify resources that support your health and wellbeing
Select the links below to learn more.
Health and Wellness Education Questions
Health Initiatives- Click Here
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.