Back to Insights and Updates for ProvidersApril 2024

Complex Care Management services

Harvard Pilgrim Health Care Commercial  |  Harvard Pilgrim Stride (HMO) Medicare Advantage  |  Tufts Health Plan Commercial  |  Tufts Health Public Plans  |  Tufts Medicare Preferred

Point32Health’s Care Management Department provides complex care management services to help adult and pediatric members attain optimal health and achieve greater self-reliance in managing their health care. Our care managers provide systematic coordination and assessment of services using evidence-based clinical guidelines. Point32Health’s complex care managers partner with community health workers, behavioral health care managers, and pharmacists to help coordinate care and access to services for members with multiple complex conditions.

Complex care management assists members with conditions such as chronic kidney disease, cancer, congestive heart failure, COPD, dementia, heart disease, asthma, diabetes, and a variety of rare diseases — as well as behavioral health conditions like depression/anxiety and serious and persistent mental illness. Care managers help patients avert the need for more intensive medical services by providing them with information tailored to their needs and stage of readiness.

Care management programs are available to members identified through:

  • Algorithms based on medical, pharmacy, and/or radiology claim analysis
  • Hospital discharge data
  • Provider and case manager referral
  • Self-referral
  • Health risk appraisal

For more information about Point32Health’s Complex Care Management program, including how to refer patients, email requests_for_care_management@point32health.org or call 866-750-2068 for Harvard Pilgrim members; email Priority_Care_Referrals@point32health.org or call 888-766-9818 ext. 53532 for Tufts Health Plan members. In addition:

Members who wish to speak with a care manager can do so by calling the appropriate number below:

  • Tufts Health Plan commercial: 888-766-9818 (TTY: 711), ext. 53532
  • Tufts Health RITogether: 866-738-4116
  • Tufts Health Together and Tufts Health Direct: 888-257-1985

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