Coordination of Care

We are dedicated to helping you manage your health. Our Care Management Program was designed to help you stay healthy and give you additional support when you need it the most. The goal of our program is to work with you and your doctor to help manage health issues and help you get the services you need to remain independent and in control of your life.

 

Integrated Care Management (ICM)

Founded in the last quarter of 2017, the MetroPlus Integrated Care Management (ICM) program is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the services and options available to meet the health and human service needs of members with complex care needs and who are at risk for increased hospital admissions and emergency room visits. The ICM program provides face-to-face interaction (when needed) to foster member engagement, member-centered care planning and goal attainment. The ICM program serves eligible members in the 5 boroughs of New York City. Care Managers complete a comprehensive assessment, identify/prioritize goals, coordinate based on member need and available resources and work with the primary care provider, specialist and other members of the health care team to develop and implement a plan of care. Periodic evaluation of progress, with interdisciplinary team meetings, are conducted and modifications are made as needed. Learn more below.

 

Behavioral Health

Life can be stressful, and sometimes you need a little help. MetroPlus can work closely with with you to ensure that you can get help from a mental health professional if you need it. Getting this kind of help doesn’t mean you are “crazy” and it doesn’t make you “weak.” You can speak with your doctor or you can contact us directly at 1-800-303-9626, and we will help you find a behavioral health professional. Click here to see our behavioral health resource tool.

Partnership in Care (for people living with HIV/AIDS)

If you are living with HIV/AIDS, this program helps you manage your condition to stay healthy. Our Case Managers help you make appointments with an HIV Specialist as your PCP and stay on top of your medications. We can also make it easier to see specialty providers such as Hepatitis C experts, dermatologists and heart specialists. For more information, see our Medicaid Partnership in Care SNP page.

Smoking Cessation

Smoking can lead to many serious health problems, like lung cancer, stroke and heart disease. Quitting is one of the biggest steps you can take to improve your health and the health of those around you. If you smoke and want to quit, we want to give you the help you need. You can call the NYS smokers hotline: 1-866-NY-QUITS (1-866-697-8487) to speak with experts. You can also visit the NY Smoke Free website.

Vaping Cessation

Vaping has become quite popular over the years and most recently appears to be associated with lung disease and death. Vaping refers to the use of electronic cigarettes (or e-cigarettes) — devices that heat a liquid, called e-liquid, into an aerosol that users inhale into their lungs. Though e-liquids do not contain tobacco, they may contain nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils, and other substances and additives. THC is the psychoactive mind-altering compound of marijuana that produces the “high”. Some of the ingredients used in E-liquids can have long term deleterious effects on health.

E-cigarettes are also called vapes, e-hookahs, vape pens, tank systems, mods, and electronic nicotine delivery systems (ENDS).

The liquid can contain: nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils, and other substances and additives. THC is the psychoactive mind-altering compound of marijuana that produces the “high”. Some of the ingredients used in E-liquids can have long term deleterious effects on health. Additionally, there is no strong evidence to support that use of e-cigarettes helps to quit smoking.

Most health insurance plans, including Medicaid, cover services to help you quit. For more information on Vaping and how to quit vaping and/or smoking, call the NYS smokers hotline: 1-866-NY-QUITS (1-866-697-8487) to speak with experts. Learn more about quitting here.You can also visit the NY Smoke Free website.

Quality Care Management Program

The goals and objectives of the Quality Management Program Description (QMP) are to support MetroPlus Health Plan in realizing its mission. The QMP facilitates the continuous improvement in medical (including pharmacy and dental) and behavioral health care and service provided to MetroPlus Health Plan’s complex, culturally and linguistically diverse membership. Learn more here.

Quality Strategy: Essential Plan

This document is designed to serve as the Essential Plan Quality strategy. This document shares our commitment to provide broad access to quality health care coverage and service to our Essential Plan members. Learn more below.

Diabetes Self-Management Education and Support (DSMES)

Diabetes Self-Management is designed to educate persons with diabetes as to the proper self-management and treatment of their diabetic condition, including information on proper diets. A new diagnosis; or a significant change in symptoms or condition which necessitates a change in Your self-management education; or when a refresher course is necessary. It must be provided in accordance with the following: By a Physician, other health care Provider authorized to prescribe under Title 8 of the New York Education Law. Diabetic supplies are provided by the pharmacy benefit.

Diabetes Self-Management Education and Support (DSMES) services help people with diabetes learn how to take the best care of themselves. Ask your doctor for a referral to DSMES services to help you manage your diabetes. Click here for more information.

Domestic Violence

Domestic Violence should not happen to anybody, but it does. And when it does, there is help. Maybe you don’t know who to talk to or have had a bad experience before when you tried to get help. We will listen to you without letting others know you called and get you the help you need. We can help you obtain resources to get you out of harm’s way.

Additional help is available. You can call these confidential numbers, 24 hours a day:
National Domestic Abuse Hotline: 1-800-799-7233 (SAFE) or, for TDD users, 1-800-787-3224
New York City Domestic Violence Hotline: 311

Resources

Integrated Care Management Program
Quality Strategy: Essentials Plan
last updated: July 14, 2022

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