Outpatient Case Management/gender health referrals

About

"Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.” (CMSA)

Nurses and licensed clinical social workers staff Kaiser Permanente’s Case Management programs. Case managers receive referrals or data to indicate that you might benefit from one of our Case Management programs. Gender health programs have a dedicated team that specializes in the aspects of care and navigation that might be needed.

Our programs and services:

• Complex case management
• Chronic condition case management
• Outpatient transition case management
• Gender health services
• Post discharge phone calls
• Medication reconciliation program

Program goals:

• Improve patient's ability to self-manage and engage in decision making for health needs
• Improve patient's navigation within healthcare systems
• Improve patient's symptom management
• Improve the patient's engagement with care management and providers
• Increase health promoting behaviors
• Improved health outcomes

To refer to case management:

Contact the case management self-referral line at 1-866-656-4183.

Complex and Chronic Condition Case Management (CCM/CCCM):

Kaiser Permanente’s Complex and Chronic Condition Case Management (CCM/CCCM) programs coordinate the care and services of members with multiple or specific chronic conditions and complicated medical/social needs often resulting in the extensive use of resources. The CCM/CCCM programs are designed to comply with the standards set for the by the National Committee on Quality Assurance (NCQA) and is integral to the accreditation for the health plan. The case managers are certified by the Commission for Case Management Certification (CCMC). The social work case managers are licensed independent clinical social workers (LICSW).

CCM/CCCM services:

• Heart failure
• COPD/asthma
• Elevated risk cardiology conditions
• Elevated risk neurology conditions
• Elevated risk nephrology conditions
• Disease management
• Member/family education
• Assessment and care planning
• Behavior modification
• Resource connection
• Member advocacy

CCM/CCCM program goals:

• 55% or greater of members are discharged as having met goals
• Member program satisfaction is equal to or greater than 90%

To refer to CCM/CCCM:

Contact the case management self-referral line at 1-866-656-4183.

Transition Case Management (TCM):

Kaiser Permanente’s Transition Case Management (TCM) collaborates with members who have short term care coordination needs primarily to assist the member with the transition from one care setting to another. The case managers are trained to engage members in these short-term transitional experiences and guide them toward their next level of care and wellness.

TCM services:

• Coordination of care
• Resource connection
• Member/family education
• Member advocacy

To refer to TCM:

Contact the case management self-referral line at 1-866-656-4183.

Gender health services program:

Kaiser Permanente has designed a care management program to serve the needs of members (with applicable benefits) who wish to explore and/or pursue gender reassignment services (GRS). Care management’s primary goal is to provide clinical guidance and support for members as they move through the process.

Gender health services:

• Patient advocacy
• Care coordination
• Benefit information
• Provider referrals
• Referrals to community resources
• Hospital utilization management

Resources for gender health services:

• WPATH clinical recommendations
• Kaiser Permanente plan surgical coverage criteria
• Mental health providers: Gender health recommendations, gender health documentation requirements
• Community mental health providers

Referral process for gender health services:
Who can refer?

• Providers
• Kaiser Permanente Customer Service
• Patient self-referral

To refer to TGS:

Contact the gender health self-referral line at 1-888-245-9004.