Standard Care Coordination Expansion Pilot

A Registered Nurse (RN) case manager makes phone contact with the member to review medications, health risks, care gaps/barriers, \& to develop a case management plan that focuses on improving medication adherence \& reconciliation, condition-based measures \& outcomes, addressing psycho-social needs, \& intensive post-admission care transition. RNs may refer the member to social workers,specialist providers, \& support programs (including to more intense case management where the primary care physician is notified that RNs may contact them to support treatment \& coordinate services).

In selected UHC markets for defined time periods, members randomized to the treatment arm also received an enhanced version of the SCC that included in-home case management support from non-clinical Community Health Workers (CHW).

RN Standard care coordination and disease management