Discharge Outreach Call Program. The Discharge Outreach Call Program assists members in understanding their post-discharge treatment plan and thereby helps prevent avoidable complications and readmissions. Within two (2) days of discharge from a Hospital, a Keystone nurse may contact a member by telephone to discuss any discharge concerns; to assess the member’s understanding of and adherence to the provider’s discharge instructions, including the timing of any follow-up appointments; to determine the member’s understandings about any medications prescribed; and to make sure any necessary arrangements for services, such as home health care, are proceeding appropriately.
Discharge Outreach Call Program. The Discharge Outreach Call Program assists members in understanding their post-discharge treatment plan and thereby helps prevent avoidable complications and readmissions. Within two (2) days of discharge from a Hospital, a Keystone nurse may contact a member by telephone to discuss any discharge concerns; to assess the member’s understanding of and adherence to the provider’s discharge instructions, including the timing of any follow-up appointments; to determine the member’s understandings about any medications prescribed; and to make sure any necessary arrangements for services, such as home health care, are proceeding appropriately. The Case Management Program is a service for members with complex medical needs or who may be at risk for future adverse health events due to an existing medical condition or who may require a wide variety of resources, information, and specialized assistance to help them manage their health and improve their quality of life. The program assigns an experienced Keystone Case Management nurse or coordinator to a member or family caretaker to help make arrangements for needed care or to provide assistance in locating available community resources. Case Management services provided to members are numerous and are always tailored to the individual needs of a member. Participation in Keystone’s Case Management Program is voluntary and involves no additional cost to our members. Services often include, but are not limited to: • Assistance with coordination of care; • Discussion of disease processes; • Facilitating arrangements for complex surgical procedures, including organ and tissue transplants; • Facilitating arrangements for home services and supplies, such as durable medical equipment and home nursing care; or • Identification and referral to available community resources, programs; or organizations. Utilization Review activities for behavioral health services (Mental Health and Substance Abuse services) have been delegated by the HMO to its contracted behavioral health management company which administers the behavioral health Benefits for the majority of the HMO's Members. Members seeking Mental Health care and Substance Abuse services may obtain Preauthorization for such services from the contracted behavioral health management company. The Disease Management Program is a collaborative program that assesses the health needs of Members with a chronic condition and provides education, counseling, and information designed t...
