Complex 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)

Kaiser Permanente’s case management programs are staffed by registered nurses and licensed clinical social workers. Case managers are assigned to the practitioner team or network area and can provide short-term, focused interventions for complex patients.

Our programs and services:

  • Complex Case Management
  • Outpatient Transition Case Management
  • Gender Health Services
  • Post Discharge Phone Calls 

Program goals:

  • Improve patient's ability to self-manage
  • Improve patient's perception of health
  • Improve patient's symptom management
  • Improve the patient's perception of being well managed
  • Increase health promoting behaviors
  • Engage patient in shared decision making
  • Financial savings 

To refer to case management:

Contact the Care Management Self-Referral Line at 1-866-656-4183.

Complex case management (ccm):

Kaiser Permanente’s Complex Case Management (CCM) program coordinates the care and services of members with multiple chronic conditions and complicated medical/social needs often resulting in the extensive use of resources. The CCM program is 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 RN case managers are at minimum bachelor’s level educated and are certified by the Commission for Case Management Certification (CCMC). The social work case managers are licensed independent clinical social workers (LICSW).

CCM Services:

  • Heart Failure
  • Disease management
  • Member/family education
  • Assessment and care planning
  • Behavior modification
  • Resource connection
  • Member advocacy

CCM Program Goals:

In addition to the standard case management goals, the CCM program works to achieve the following 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:

Contact the Care Management Self-Referral Line at 1-866-656-4183.

Transition case management (tcm):

Kaiser Permanente’s Transition Case Management (TCM) works with members who have short term care coordination needs primarily to assist the member with the transition from one care setting to another. The RN case managers are at minimum bachelor’s level educated and are certified by the Case Management Society of America (CMSA).

TCM Services:

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

To Refer to TCM:

Contact the Care 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?

  1. Providers
  2. Kaiser Permanente Customer Service
  3. Patient Self-Referral

To Refer to TGS:

Contact the Care Management Self-Referral Line at 1-866-656-4183.