Care Management

Physicians Health Plan strives to collaborate with providers to accomplish our common goal of delivering great service that ensures the well-being of those we serve. To help accomplish that, PHP offers several tools to help you, and your patients, manage their health.

Disease Management

PHP believes strongly in partnering with members and their healthcare providers in managing diseases, ensuring that patients understand diagnoses and developing a personalized care program.

Medication Therapy Management (MTM)

Patients who are chronically ill or have many health conditions can sometimes be overwhelmed by the number of medications needed to managed their care. If you are a patient covered under PHP, our free MTM program can help. Medication Therapy Management is an innovative pharmacist-directed program that helps patients understand and manage their medication regimen, and assists prescribers in avoiding potential medication-related problems. Click here or call our Pharmacy Department at 517.364.8545 to find out more.

Medical Resource Management (MRM)

Medical Resource Management is a highly structured and clinically intense set of processes that attempts to facilitate members’ access to healthcare resources, decrease the “hassle” factor and improve the overall healthcare experience. The Medical Resource Management Department aims to improve relationships between doctors and patients by offering more resources than traditional healthcare programs and by making it easy for patients to access the information they need about medical concerns.

These are some of the functions performed in MRM:

Health Education with a Personalized Approach

We provide reminder programs for routine check-ups, including flu shots, Pap smears, immunizations and mammograms. PHP also makes available our Healthy Mom, Healthy Baby program, which helps expectant mothers obtain the information they need to experience a healthy pregnancy.

Hospital Review

We will facilitate access to specialists, help to make treatment plans timely – and prevent delays in patient procedures and tests whenever we can. The Medical Resource Management Department also provides services for ensuring that the discharge process goes smoothly and that all necessary equipment and supplies are available when your patients need them.

Life360 Programs That Empower Our Members

We will help empower members who have conditions such as asthma and diabetes by providing the information they need – everything from self-care education materials to health status tracking. This is intended to supplement the medical advice supplied by providers.

Post-Hospital Discharge Program

This provides a safe transition home after a hospital admission. After leaving the hospital, our Case Management nurses will call members to make sure that medication, self-care information and supplies are easily accessible, helping ensure a positive outcome from the care you provided or oversaw.

Complex Case Management Offers All the Resources Patients with Complex Illnesses Need

Chronic conditions are difficult enough to manage without worrying about coordinating long-term outpatient treatment programs. PHP makes outpatient care as easy as possible. Our Complex Case Management program focuses on stabilizing long-term outpatient care for members with complex conditions. If you have patients enrolled with PHP who would like to speak to a nurse about complex case management, please ask them to call 517.364.8560 or toll-free 866.203.0618.  
Click here for a Care Management Referral Form.

Medical Resource Management Process Description
Prior Authorization   Authorization-Notification Table
Hospital Stay Review
  • Care delivered in most appropriate setting
  • Reduce delays in access to tests and procedures
  • Plan appropriately for discharge
Post-Hospital Discharge Assessment
  • Post-hospital discharge for targeted diagnosis
  • Provide assistance with in-network medical specialties
  • Educate about medical conditions and medications
  • Offer self-help tools and disease-specific education
  • Assist with follow-up for clinical care, physicians orders, post-hospital appointments
  • Provide support with supplies, equipment and community resources
Complex Case Management
  • Address gaps in care
  • Provide access to specialists
  • Educate about medications and disease process
  • Offer self-help tools and information on disease process
  • Assist with follow-up for clinical care, specialty physicians, medications and diagnostic testing
  • Provide support with supplies, equipment and community resources
  • Click here for a Case Management Referral Form
Transplant Services
  • Care delivered in most appropriate setting by designated transplant network
  • Assist with discharge planning
  • Assist with follow-up for clinical care, physician appointments, required post-transplant-related care