OptionPlus sm Program

The Preferred Care OptionPlus program brings together a dedicated team of nurses and social workers trained to manage the unique needs of Preferred Care Option (Medicaid) members.

The program is community focused with collaboration from a variety of community service agencies. We work closely with the Departments of Social Services to identify and case manage our members on an individual basis. Our nurses and social workers are available telephonically and will make select home visits as needed.

Members are identified for the program based on criteria that include:

• 100% review of health risk assessment for new enrollees.
• Post-hospitalization stabilization.
• Frequent emergency room use.
• Community referrals.
• Provider referrals.
• Member self-referrals.

Interventions include:

• Management of medical treatment plans in collaboration with the member, the provider and specialists.
• Comprehensive psychosocial assessment of the entire family.
• Health risk assessments.
• Depression and safety screenings.
• Triage to our multiple disease management programs and behavioral health services.
• Referral to community agencies.
• Benefit management.
• Team conferences and collaboration with community programs.
• Telephonic and/or home visit assessments of environment and physical status.
• Discharge planning.
• Long-term planning.

The OptionPlus team works closely with members to access needed, and sometimes difficult to navigate, health care support. The medical needs of this population are numerous and complex and the majority require co-management and expertise from both the clinical and social work staff. Our focus is on establishing long-term relationships and providing assistance in meeting members' most critical needs. Each new enrollee receives a personal letter from their case manager inviting them to call for assistance at any time.

To provide a full-service, customer-focused program, the OptionPlus team works collaboratively with Preferred Care sales, marketing and outreach services.

We are proud of our 85% contact rate for the program. For the members we successfully contact, we have a 99.8% participation and retention rate for the program.

How to Get Your Patient Involved
If you would like additional information about the OptionPlus program or would like to refer a member for enrollment, please call the Preferred Care OptionPlus Enrollment Specialist at (585) 258-8666 or 1-800-933-3920, ext. 8666.

Last updated: August 30, 2007