Care Managment Process

Member Identification:

• Telephone assessment by nurse care coordinators
• Face-to-face or telephone assessments by social workers
• Hospital rounds on antepartum floors, evaluation units, and in Le Bonheur’s NICU and PICU
• Weekly lists of high-risk members being provided by the perinatologist’s office staff
• Health plan referral
• Self-referral

Member Risk-Stratification:

Risk stratification is the method used to identify high and low-risk members for medical conditions.

• Level III Clinical OB nurses provide initial telephone assessments of each newly enrolled member. (Based upon this assessment a risk stratification of either low or high is assigned)
• Nurses coordinate the medical care for all high-risk pregnant women and NICU graduates.
  

• Level III Social workers provide daily hospital rounds to identify and assess antepartum, post-partum, NICU and PICU members and their family support systems.
• Provide outreach services for NICU graduates
• Assist with the coordination of mother’s breast milk initiatives
• Maintain offices in the major OB clinics
• Perform medical record reviews
• Provide face-to-face psychosocial assessments and review educational materials
• Refer members to appropriate community resources for economic and psychosocial support.
  

Members that have both medical and psychosocial high-risk factors will receive complex care management and are managed collaboratively by both the nurse and social worker.