Back to Insights and Updates for ProvidersNovember 2023

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 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.

These programs assist 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 (SPMI). 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. Comprehensive whole person management allows for integration and support for the member’s total medical care and treatment plan through intensive care management.

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 programs, including how to refer patients, email [email protected] or call 866-750-2068 for the Harvard Pilgrim platform; email [email protected] or call 888-766-9818 ext. 53532 for the Tufts Health Plan platform. 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

*Editor’s note: We have updated this article to update the presentation of contact information.

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