Specialized Care Management Programs
Personalize care. Manage risk.
Improve outcomes.
Toney Healthcare offers a range of specialized care management programs that focus on a health plan’s highest risk and rising-risk members to reduce avoidable utilization, lower costs and improve outcomes while helping members achieve optimal levels of health. These programs can be deployed individually or as a comprehensive whole.
We believe that effective care management addresses behavioral health (BH) and social determinants alongside physical health, so our programs support strong collaboration across the care continuum and positively impact utilization, costs, care gaps, health equity, and member and provider experience. We work in your systems environment, so all care management actions and outcomes are fully and immediately transparentto you, without data transfers. All data stays in your control.
Dedicated Teams. Deep Expertise.
Our care management professionals have years of experience with health plans across the country, bringing innovation and a wealth of knowledge in best-practice health management and national and regional perspectives for all lines of business and population types. Our clinicians are all US-based and appropriately licensed, with the experience, expertise and training to support medical, behavioral health and social determinants of health (SDOH) across disciplines.
Interdisciplinary, Multi-Tiered Approach for High Risk Care Management
To have the greatest impact, we offer several care management programs that align with different levels of risk—available individually or combined in a comprehensive offering, with cross-referral support to step up or down to different risk levels. Our care management programs empower plans to:
Manage and reduce medical and behavioral health utilization and healthcare costs
Improve communication and coordination between member care and treatment teams
Advance treatment plan understanding and adherence
Help members achieve their optimal level of health
Support members between physician visits
Specialized Care Management Programs at a Glance
Ultra-High Risk Care Management
TARGET:
Top <1%—Members with the highest risk, cost, and utilization who are not responsive to traditional care management programs.
PROGRAM:
This program employs a high-touch, interdisciplinary care team to target vulnerable, high-risk individuals to keep them engaged and coordinate services to support medical, behavioral, and SDOH. Community health workers are deployed to engage, screen and support members while an RN or behavioral clinician acts as primary care manager depending on focus. Key interventions include care coordination, ICT meetings, chronic condition and care transition support, medication reconciliation and pharmacy, ongoing communication with treating providers, Progressive Cognitive Resonance behavior modification, in-person support for physician visits, and SDOH support (e.g., transportation, food, safe living, homemaker services).
TEAM:
Dedicated interdisciplinary care team including RN care manager, BH (LCSW) care manager, community health worker, social worker, pharmacist, and physician (geriatrician for older populations).
Integrated Case Management
TARGET:
Top 1% to 2%—High-risk individuals with acute needs or complex conditions, stratified to high, medium, and low risk levels.
PROGRAM:
Comprehensive case management for unstable, complex conditions, focusing on the physical, behavioral and social needs of participants. Supports multi-chronic conditions, post-acute care and readmission avoidance, as well as serious behavioral health concerns such as severe mental illness (SMI) and substance use disorder (SUD). Specialized tracks for autism spectrum disorder/ABA and dementia care management are also available.
TEAM:
RN care manager and a BH (LCSW) care manager, with support from a pharmacist and physician as needed.
Med-Psych Care Management
TARGET:
Next 2% to 10%—High- to medium-risk individuals with chronic conditions exacerbated by underlying, undiagnosed/under- or untreated mild to moderate behavioral health conditions and psychosocial barriers.
PROGRAM:
We manage these vulnerable, “missed members” through our specialized therapeutic intervention model, called Progressive Cognitive Resonance (PCR), which is based on cognitive behavioral therapy and delves into the root psychological, social and physical drivers of poor health and avoidable utilization. While the approach is from a behavioral angle,the greatestimpactis on physical health costs, utilization and outcomes. Learn more.
TEAM:
Team includes licensed behavioral health clinicians (e.g., LCSW) trained in PCR who help individuals overcome barriers to optimal health, supported by RNs and physicians as needed to address physical health issues.
Toney Healthcare’s team of experts is ready to help you address your utilization, care and behavioral health resource needs with plug-and-play health management services and expertise so you get the help you need, fast—and without HR headaches.