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Care Management Programs

We are here to help. As a Cook Children’s Health Plan member, you may be eligible for one of our Care Management programs at no cost to you.

Health and Wellness Program

The Health and Wellness Program promotes health screenings and wellness programs for improved health. We offer tools that provide you with information to promote health and wellness, including:

  • Healthy weight maintenance
  • Quitting smoking
  • Encouraging physical activity
  • Healthy eating
  • Managing stress
  • Avoiding at-risk drinking
  • Identifying depression symptoms
  • Diabetes Education

Disease Management (DM) Programs

If you have asthma or diabetes, our Disease Management Program can help you. We will mail you information to help you understand and manage your condition. You may also receive a call from one of our team members. They will:

  • Help you create health goals and make a plan to reach them.
  • Support you through one-on-one phone calls.
  • Provide you information about local support resources.
  • Answer any questions you might have about your condition and your treatment plan.
  • Coordinate your care with your health care providers.

Please click here for asthma and diabetes resource information.

Baby Steps Program

Pregnancy is an amazing time for a woman. It can also be a time full of questions. The Baby Steps team is here to answer your questions. Our team is made up of nurses and community health workers. They will send you pregnancy, postpartum and newborn information. If you have a high-risk pregnancy, you will have a Case Manager. The Case Manager will answer questions and help you find any services you need. A high-risk pregnancy means you have something that raises your or your baby’s chance for health problems or early (preterm) delivery.

For more information, please click call our Member Services Department at 800-964-2247.

Case Management & Service Management/Complex Case Management/Service Coordination Programs

Our Members with Special Health Care Needs (MSHCN) are eligible for these programs. A MSHCN is someone who:

  • Has a serious ongoing illness, a chronic or complex condition or a disability that will likely last for a long period of time
  • Requires regular, ongoing treatment and evaluation for the condition by appropriate health care personnel

You will have your own Case Manager or Service Manager/Coordinator. They will help you get the services you need by:

  • Completing an assessment to identify your needs.
  • Creating a service plan or care plan to meet your needs.
  • Talk to you about the plan to make sure you understand and agree
  • Work with you and your doctors to help you get needed services

Cook Children’s Health Plan has multiple avenues for members to be considered for complex case management services, including, but not limited to:

  1. Medical management program referral
  2. Discharge planner referral
  3. Member or caregiver referral
  4. Practitioner referral

Referral Process

Each referral is reviewed to enroll members in to Complex Case Management based on available information and telephonic member assessment. Participation in this program is voluntary and at no cost for all eligible Cook Children’s Health Plan members. If you would like to refer a member or if you would like more information about eligibility for this program, please call 1-800-964-2247 (Monday through Friday from 8:00 am to 5:00 p.m. local time).

How to Join One of Our Care Management Programs

You do not need to have a referral from your doctor to join. If you qualify for any of these programs, you can call us at 1-800-964-2247 Monday through Friday from 8:00 am to 5:00 p.m. local time. Members that are eligible for any of these programs that require contact between them and Cook Children’s Health Plan staff will receive the following information:

  • How they became eligible for the program
  • How to use program services
  • How to opt in or out of the program

Care Management Program outreach and ongoing management for our members will be made by phone. All calls are live between Care Managers and the member. If you do not want to join any of these programs, you can opt out at any time by calling the same number. This means that we will take you out of the program but it will not affect your benefits.