HMSA's Care Management operating model is aimed at improving outcomes for members with the greatest medical complexity while strengthening support for the physicians and care teams who serve them. The approach focuses HMSA’s clinical programs on early identification, timely intervention, and integrated care coordination.
Health Management programs will prioritize the highest‑risk members across all lines of business. Engagement will begin at key trigger points such as hospital admission, emergency department visits, or other clinically significant events. Members will then be supported through an integrated care‑pod model designed to foster collaboration among nurses, care coordinators, social workers, and other clinical professionals.
The programs will concentrate on several priority areas:
- Reducing avoidable emergency department utilization
- Improving transitions of care following hospitalization
- Supporting high‑risk members, including those with three or more chronic conditions
- Enhancing care for individuals with high‑risk pregnancies
In addition, the Healthy Living program will offer tailored services to meet the unique needs of our commercial population to address specific populations identified by employer groups, expanding preventive support and improving member engagement.
Click on the links below for Health Management program materials designed to help providers and office staff engage with their patients.
- Care Management Programs Referral Form [PDF]
- Long-Term Services and Supports (LTSS) Referral Form [PDF]
- Advanced Care Program [PDF]
- Transitions of Care Program [PDF]
- ED Care Pathways [PDF]
- High-Risk Pregnancy [PDF]
- Healthy Living [PDF]
Click on the links below for Health Management program materials designed to inform members.
- Advanced Care Program [PDF]
- Transitions of Care Program [PDF]
- ED Care Pathways [PDF]
- High-Risk Pregnancy [PDF]
- Healthy Living [PDF]
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform |