Search
Popular Tasks
Visit a ConnectiCare center
Improving the patient experience
- Commercial
- Medicare
An overview
ConnectiCare takes a Total Population Health (TPH) Management approach to the overall care management of its members by providing broad access to coordinated health care services that improve health outcomes while reducing health care costs. ConnectiCare’s TPH Model of Care provides a personal health care manager, a partnership with the member’s physician, locally based teams of multi-disciplinary staff, help in understanding and managing member’s medications, support during and after hospitalization, and a connection to community resources.
Members who are enrolled in active care management benefit from a personalized care plan developed and supported through one-on-one interactions with a registered nurse or social worker who oversees the care plan and coordinates with the rest of the TPH care management team. The care management team, which includes registered nurses, social workers, community health educators, field care managers, behavioral health clinicians, pharmacists, and medical directors, work together to ensure there is integration and connection of medical and community services.
Care Transitions Program
The ConnectiCare Care Transitions Program recognizes the known potential risks associated with transitioning from one practice setting to another. ConnectiCare’s program focuses on transition from acute and subacute facility to home with the goal to prevent acute readmission.
Risk stratification
ConnectiCare risk stratification process ranks members according to a risk score that is determined from a review of medical claims over a rolling 12-month look-back. A prospective risk score, internal utilization-based risk score, and a co-morbidity score are combined to produce a total risk score and overall ranking. Risk scores are mapped to a high, moderate or low risk group. Members who are determined to be high risk are managed in Complex Care Management and members who are moderate risk with one or more of five chronic conditions (asthma, CAD, CHF, COPD and diabetes) are managed in disease management.
Complex care management is defined as the coordination of care and services provided to members who have experienced a critical event or diagnosis requiring the extensive use of resources and who need help navigating the system to facilitate appropriate delivery of care and services. ConnectiCare’s program goal is to help members regain optimum health or improved functional capability, in the right setting and in a cost-effective manner.
Disease management is defined as the process of assessment, planning, coordination of services and education with a focus on specific chronic conditions such as diabetes, asthma, heart failure, coronary artery disease, and chronic obstruction pulmonary disease. ConnectiCare’s disease management program is designed to produce the best possible outcomes for members, identify opportunities in care and service (e.g. closure of gaps in care), collaborate with providers about the member’s treatment plan in accordance with recommendations from national clinical guidelines and promote cost savings.
ConnectiCare also offers QuitCare, a smoking cessation program, for members who are ready to quit smoking. QuitCare is a telephonic program that includes unlimited quit coaching support from a Master Certified Tobacco Cessation Treatment Specialist, educational materials, coverage for over-the-counter nicotine replacement therapy (under the pharmacy benefit), and physician-prescribed medication for smoking cessation (also covered under the pharmacy benefit).
ConnectiCare develops and further enhances its TPH management programs in consultation with local physicians, primarily by leveraging the collaborative relationships we have with our provider groups and the practicing physicians who are voting members of ConnectiCare’s Quality Improvement Committee. Physicians regularly receive information from ConnectiCare about their patients including those who have been seeking non-urgent care at the emergency room, have clinical gaps in care, have an update to their authorization status or are enrolled in TPH care management. Any confidential member information received should be filed in the member’s medical record. If you do not want to receive these mailings, please contact our TPH Care Management Department at the number below. If you do not want to receive these mailings, please contact our TPH Care Management Department at 1-800-390-3522.
Updates of a more urgent nature may be deemed necessary by the TPH care manager in the event a member's health condition has changed. In this instance, the care manager will attempt to contact the physician by phone.
If you would like to know more about ConnectiCare’s TPH management program content, printed copies of the TPH program-care management description, educational materials and mailings to members are available upon request.
ConnectiCare also relies on practitioners to refer patients to TPH care management.
Practitioner Rights
Practitioners who participate in ConnectiCare’s TPH management programs have the right to:
- have information about ConnectiCare’s programs and services, including the staff, the staff qualifications, and any contractual relationships related to TPH management programs.
- be informed of how ConnectiCare’s programs coordinate interventions with treatment plans for individual members.
- know how to contact the person responsible for managing and communicating with the practitioner's patients.
- be supported by ConnectiCare’s programs to make decisions interactively with members regarding their health care.
- receive courteous and respectful treatment from ConnectiCare staff.
- communicate complaints to ConnectiCare.
- decline participation in TPH management programs.
PPM/10.16 |
Program overview
ConnectiCare’s Quality Improvement Program (QIP) was developed to improve the physical and mental well-being of its members, and to promote the delivery of high quality care and service. We embrace the continuous improvement model to ensure that the care and services provided to our members meet or exceed established local, state, and national managed care standards. As a result, ConnectiCare will better serve the needs of members, employers, and participating practitioners and providers.
The Emblem Quality Improvement Committee (QIC) is the ConnectiCare governing body. The overall responsibility for the development and functioning of the QIP resides with ConnectiCare’s vice president, Stars and Quality Initiatives and the Quality Management Committee (QMC). The QMC under the direction of the vice president, Stars and Quality Initiatives and the director, Stars and Quality Initiatives have the responsibility for planning, designing, implementing and coordinating QI activities.
Participating physicians may be involved in some or all of the following QI activities:
- Activities that promote continuity and coordination of care between medical specialties and behavioral health specialties.
- Surveys on various QI activities such as your satisfaction with ConnectiCare.
- Receipt of a list of members who have gaps in care with a request to contact members to close gaps in care
- Submission of supplemental data for HEDIS
- Trainings on HEDIS® or other quality related programs
- Medical record review for HEDIS® or Centers for Medicare & Medicaid Services (CMS) reporting requirements
- Receipt of a list of members on certain medications with recommendations for follow-up
- Recredentialing activities, which may include a site visit and/or a review of medical records of your ConnectiCare patients
- Receipt of education materials or guidelines on ConnectiCare’s clinical quality, preventive health or total population health programs
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
ConnectiCare has many programs to help maintain or improve the health of our members, including:
- Breast and cervical cancer screening
- Chlamydia screening
- Colorectal screening
- Comprehensive diabetes management including
- HbA1c testing and management
- Retinal eye exam performance
- Medical attention to nephropathy
- Statin therapy
- Follow-up after a mental health hospitalization
- Follow-up care for children prescribed ADHD medication
- Immunizations related to
- Influenza
- Childhood (up to age 2)
- Adolescents (between 11 and 13 years of age)
Participating physicians may obtain more detailed information regarding our Quality Improvement Program, as well as a report of how we are performing against standards, by calling us at 1-860-674-5850 or 1-800-828-3407. Visit our website to view our preventive health guidelines, which ConnectiCare developed based on nationally accepted guidelines and with input from various participating physicians, as part of our Quality Improvement Program. To request a hard copy, call 1-860-674-7029.
PPM/10.16 |
Health management programs
Special programs for people with specific health conditions. [more]
Practice guidelines
Suggested guidelines for the diagnosis and management of chronic conditions. [more]
Preventive Health Guidelines
Provides guidelines for members on recommended immunizations and testing. [more]
Healthy Alternatives
Additional healthy services members have access to. [more]
An overview
ConnectiCare defines chronic care improvement as a method for identifying a population of members with a specific disease or condition, and helping to manage that population in the context of an integrated, multi-disciplinary approach.
The objectives of the Chronic Care Improvement Programs include: promoting measurable improvement in members’ health status through self-assessment and management of symptoms, promoting physician compliance with nationally recognized treatment guidelines, and ultimately reducing the overall costs associated with chronic disease.
ConnectiCare members with chronic obstructive pulmonary disease, diabetes, heart failure or coronary artery disease will receive mailings describing our Chronic Care Improvement Programs and the benefits of participation. Members who are identified at highest risk through medical claims or risk assessment, and choose to participate, will receive regularly scheduled contacts from a nurse case manager, as well as written information on managing their condition.
ConnectiCare Chronic Care Improvement Programs
Programs developed and implemented to date include:
Title |
Target Condition |
Physician Audience |
Inception Date |
BREATHE |
Chronic obstructive pulmonary disease |
Family Practice, Internal Medicine, Pulmonologists |
2008 |
DiabetiCare |
Diabetes |
Endocrinologists, Family Practice, Internal Medicine |
2008 |
Heartcare |
Heart failure |
Cardiologists, Family Practice, Internal Medicine |
2008 |
|
Coronary artery disease |
Cardiologists, Family Practice, Internal Medicine |
2008 |
ConnectiCare does not maintain any financial ownership arrangements between itself and any other entity engaged in advertising, marketing, or the provision of goods and services offered through ConnectiCare’s Chronic Care Improvement Programs. In addition, ConnectiCare does not advertise, market, or promote any specific products or services to members or practitioners when discussing a member’s health condition. |
ConnectiCare develops its Chronic Care Improvement Programs in consultation with local physicians. As programs are developed, ConnectiCare distributes program documentation to physicians who, based on their specialty, may have patients who would benefit from these specific programs. These routine program updates may include periodic reports, updated guidelines, or notification of a member’s participation. Any confidential member information received should be filed in the member’s medical record. If you do not want to receive these mailings, please contact our Chronic Care Improvement Programs Department at the number below.
Updates of a more urgent nature may be deemed necessary by the nurse case manager in the event a member's health condition has changed. In this instance, the nurse case manager will attempt to contact the physician by phone.
If you would like to know more about specific program content, visit our Health Management Center section. Printed copies of program descriptions, educational materials and mailings to members are available upon request.
To enroll one of your patients in a program or if you have any comments or complaints about a Chronic Care Improvement Program, contact the Medicare Case Management Unit, Monday - Friday, 8 a.m. - 4 p.m., at 1-800-829-0696.
Practitioner Rights
Practitioners who participate in ConnectiCare’s Chronic Care Improvement Programs have the right to:
- have information about ConnectiCare’s programs and services, including the staff, the staff qualifications, and any contractual relationships related to Chronic Care Improvement Programs.
- be informed of how ConnectiCare’s programs coordinate interventions with treatment plans for individual members.
- know how to contact the person responsible for managing and communicating with the practitioner's patients.
- be supported by ConnectiCare’s programs to make decisions interactively with members regarding their health care.
- receive courteous and respectful treatment from ConnectiCare staff.
- communicate complaints to ConnectiCare.
- decline participation in Chronic Care Improvement Programs.
Medicare PPM/2.11
Program overview
ConnectiCare does not advertise, market, or promote any specific products or services to members or practitioners when discussing a member’s health condition. |
ConnectiCare’s Quality Improvement Program (QIP) was developed to improve the physical and mental well-being of its members, and to promote the delivery of high quality care and service. We embrace the continuous improvement model to ensure that the care and services provided to our members meet or exceed established local, state, and national managed care standards.
The Quality Assurance Committee (QAC), comprised of members of the Board of Directors and network physicians, is the governing body of the QIP. The overall responsibility for the development and functioning of the QIP resides with ConnectiCare’s chief medical officer and the Quality Management Committee (QMC). The QMC under the direction of the senior medical director and the responsibility for planning, designing, imple- menting and coordinating QI activities.
Participating physicians may be involved in some or all of the following QI activities:
- Activities that promote continuity and coordination of care between medical specialties or medical and behavioral health specialties.
- Surveys on various QI activities such as how you care for patients with depression or your satisfaction with ConnectiCare.
- Receipt of a list of members who have care opportunities.
- Receipt of a list of members on certain medications with recommendations for follow up.
- ConnectiCare’s physician advisory committee.
- Recredentialing activities, which may include a site visit and/or a review of medical records of your ConnectiCare patients.
- Medical record review for HEDIS® reporting requirements.
- Receipt of educational materials or guidelines on ConnectiCare’s clinical quality, health management or preventive health programs.
- A ConnectiCare-sponsored education seminar or symposium.
HEDIS ® is a registered trademark of the National Committee for Quality Assurance (NCQA). ConnectiCare participates, along with many other health plans, in the New England HEDIS ® Coalition. Participants in the coalition make a commitment to measure their health plan’s performance in the delivery of selected services in the broad categories of preventive medicine, prenatal care, acute disease and chronic disease.
ConnectiCare has many programs to help maintain or improve the health of our members, including:
- Breast and cervical cancer screening
- Chlamydia screening
- Cholesterol screening
- Colorectal screening
- Depression medication adherence program
- Depression: screening & management
- Follow-up after a mental health hospitalization
- Influenza immunizations
- Postpartum depression screening
For more information on how we are performing against standards, click here or call us at 1-877-224-8230.
View our preventive health guidelines, which ConnectiCare developed based on nationally accepted guidelines and with input from various participating physicians, as part of our Quality Improvement Program. To request a hard copy, call To request a hard copy, call 1-877-224-8230.
Medicare PPM/7.20
Health management programs
Special programs for people with specific health conditions. [more]
Practice guidelines
Suggested guidelines for the diagnosis and management of chronic conditions. [more]
Preventive health guidelines
Provides guidelines for members on recommended immunizations and testing. [more]
