Care Management

Care Management Program 

Our free Living Healthy programs are available to all Martin’s Point health plan members. As an extension of your care team, we’ll help make sure your patients are following the treatment plans you recommend, taking the medications you prescribe, and successfully managing the conditions you diagnose and treat. To refer a patient to our program, please call 1-866-800-8833.Martin’s Point offers the following care management activities:
Chronic Care Management: Working with a nurse care manager to better understand their chronic conditions, ensure coordination with community providers, adhere to treatment plans, manage medications, improve self-management skills, and take proactive steps towards feeling better.
Transitions of Care: Working with a care manager to follow up after transition to home, complete medication reconciliation, provide education, review treatment plans, and coordinate follow-up care with community providers.
Behavioral Health: Working with a social work care manager to assist with both transitions to home and longer term support, review treatment plans, provide education, manage medications, improve self-management skills, and take proactive steps toward feeling better.
Maternity: Working with a nurse to provide maternal health care management during and after pregnancy to promote the best opportunity for positive health outcomes.

Health Management Communications and Resources

24/7 Nurse Advice Line
Health Plan members enjoy 24/7 access to trained nurses who can answer their health questions. This service is provided by SironaHealth in partnership with Martin’s Point. Members can call anytime with questions about symptoms, injuries, or illness. US Family Health Plan members can call 1-800-574-8494. Generations Advantage members can call 1-800-530-1021

Healthwise Knowledgebase
Healthwise Knowledgebase is an online resource that offers comprehensive health information to help our members make decisions about their health. Providers and members can access this resource here

View Prior Authorization Guidelines

Clinical Guidelines

At Martin’s Point our utilization reviewers adhere to clinical guidelines that are based on scientific evidence published in peer-reviewed medical literature that is recognized by the medical community. This ensures that our members receive consistent, high-quality care while avoiding inappropriate or unnecessary procedures, services, and expense. There are no incentives (financial or other) to deny care. Utilization reviewer decisions are based only on appropriateness of care and existence of coverage.

These guidelines are reviewed annually by the Martin’s Point Health Plan Clinical Quality Management Committee (HPCQMC). Guidelines, processes, and updates are also communicated to providers regularly through our Provider Manual and newsletter, The Point. If you have questions or would like a paper copy of these guidelines, please call 1-866-800-8833.

Preventive Care Benefits
Preventive care benefits are designed to keep patients healthy and identify health problems in the early stages. Martin’s Point covers many preventive services at no cost to the member to support early detection of disease or disease precursors in apparently well individuals. Eligible preventive care services vary by health plan, but most are based on recommendations from the US Preventive Services Task Force and/or other federal government or independent agencies responsible for the development and monitoring of various US preventive care guidelines. Preventive care services are covered in accordance with the requirements set forth in the Patient Protection and Affordable Care Act. For a list of covered preventive services, please visit:
Generations Advantage
US Family Health Plan 

Generations Advantage Focus DC (C-SNP)

Chronic Condition Special Needs Plan Focused on Diabetes Care

MODEL OF CARE

Medicare Advantage Special Needs Plans are designed to provide targeted care and services to individuals with unique needs. The Generations Advantage Focus DC plan (C-SNP) is a Chronic Condition Special Needs Plan designed for Medicare-eligible people diagnosed with diabetes as a chronic or disabling condition.

Network providers can find an overview of the plan, its Model of Care, and the benefits your patients receive on the plan at: Generations Advantage Focus DC (C-SNP) Model of Care Information For Providers