Health Services

SummaCare has Registered Nurse Care Managers and a Social Worker available to provide services as follows: 

• Assistance with transitioning home after acute admissions
• Assistance with finding needed care within the network
• Education in management of multiple co-morbid conditions and how to self-manage 
• Coordination of arrangements for complicated plans of care and catastrophic/highly complex medical needs
• Assistance with coordination of referrals to community resources for long term planning
• Management of social determinants of health
• Advanced care planning

Enrollment Criteria:

• All SummaCare Medicare Individual and Group plans, All Commercial Fully-Insured, Self-Insured groups on case-by-case basis 

Description

• High-risk pregnancies
• Care Manager provides telephonic visits with the member
• Assessment
• Education on condition
• Evaluation of social determinants; referral to all needed community resources
• Coordination of all care, early detection of issues and communication with OB/GYN

Enrollment Criteria

• SummaCare Fully-Insured and Medicare members, select Self-Insured groups employees/dependents
• Identification of high-risk pregnancy (i.e. multiple gestation, hx preterm labor, hx HTN/eclampsia, chronic conditions, tobacco use, unplanned admissions, fetal complications)

Description

• Targets members who have chronic care needs with ambulatory sensitive conditions who have difficulty getting out to a primary care physician’s office for care
• Members receive home visits from a Medical Doctor or Advanced Practice Nurse

Enrollment Criteria

• SummaCare member 
• Physical dependence in at least one ADL AND two IADLs 
• Has diabetes, hypertension, COPD, CHF, pneumonia, dementia, Alzheimer’s disease or other chronic conditions 
• Requires taxing effort to get to a provider’s office

Description

• Home based palliative care which provides support to seriously ill members and their families in coordination with their physician
• Visits provided by palliative prepared RN and LSW 
• Social determinants of health 
• Ongoing assessments of physical, psychosocial and spiritual well-being 
• Community resources 
• Help with relieving pain and other symptoms
• Advance Care Planning

Enrollment Criteria

• All SummaCare Medicare Individual and Group plans, All Commercial Fully-Insured, Self-Insured groups on case-by-case basis 
• Lives throughout the service area 
• Serious illnesses such as metastatic cancer, progressive neurological conditions, stroke, advanced pulmonary, cardiac or liver disease with any of the following: 
  • Difficult to control symptoms 
  • Declining ability to care for themselves 
  • Frequent hospital and/or ED visits 
  • Limited social support or overwhelmed caregivers 
  • Patient/family uncertainty regarding treatment decisions

To make referrals, please contact CareCentrix directly at referrals@turn-keyhealth.com or call 234.867.7015

Registered nurses provide valuable tools and resources to help our members better manage their chronic conditions and to maintain and improve quality of life.

• Condition-specific preventive and self-care education
• Assessment and development of plan of care
• Ongoing monitoring of claim patterns for gaps in recommended care
• Reminders to seek recommended care
• Nurse outreach to members
  • newly diagnosed with the condition
  • high-risk for hospitalization
  • after hospitalization for the condition

Enrollment Criteria

• SummaCare Medicare, Fully-Insured Commercial and Individual members, select Self-Insured groups
• Asthma, COPD, diabetes, depression, A-fib, CHF, HTN, CAD, and CKD
• Excludes: members enrolled in SNF/ICF, BTH, CCM, palliative care
• Includes: assisted/independent living, home care

Description

• In-home remote monitoring of symptoms and biometric readings of members with chronic conditions
• Daily transmissions of data from member to nurse who reviews alerts and takes action
• Members are provided with education of conditions, cause and effect, diet, medication use and identification of early exacerbation
• Provides coordination of care with PCP/ordering physician

Enrollment Criteria

• SummaCare Medicare, Fully-Insured Commercial and Individual members, select self-insured groups
• Must have diagnosis of heart failure, coronary artery disease, chronic obstructive pulmonary disease, hypertension, diabetes

If you would like to speak directly to Medtronic’s PASS RN team about a patient or reporting, please call 866.581.3897 or email pass@medtronic.com. 

Description

Telephonic coaching provided by a registered dietitian and/or exercise specialist

• Nutritional counseling and MNT
• Weight management
• Physical activity recommendations and planning
• Fall prevention
• Biometric results and potential risk factors

Support members with lifestyle changes through health coaching

• Use motivational interviewing and behavior change techniques
• Assist with setting SMART goals
• Follow up and accountability

Enrollment Criteria

• SummaCare Medicare, Fully-Insured Commercial and Individual members, select Self-Insured groups
• Excludes: members enrolled in SNF/ICF, BTH, CCM, palliative care
• Includes: assisted/independent living, home care