In this chapter you will find quality improvement programs available to help members with identified conditions and diseases.
In this chapter you will find quality improvement programs available to help members with identified conditions and diseases.
EmblemHealth has health and wellness programs, tools, and resources to help members enhance their quality of life. For tips and information on preventive care, wellness benefits, chronic disease management, self-care, and more to share with our members, visit emblemhealth.com/live-well.
EmblemHealth promotes the following quality improvement initiatives through newsletters and other educational materials available to members and providers:
Women's Health
Adult Health
Childhood and Adolescent Health
Activities and Goals
EmblemHealth has a Population Health Management model that identifies prospective high-risk members who require help to meet their care needs. EmblemHealth's care management goal is to address our members’ needs in the following focus areas:
Using sophisticated predictive modeling tools, we can identify members with evolving risks and provide them with care as early as possible. We can also identify members who would most benefit from field-based care management. Our programs and initiatives are designed to complement the traditional medical care our members receive.
Activities include, but are not limited to:
Program goals include:
Members are identified for these programs through our analysis of:
Practitioners may refer members to our care management programs, or the member may contact us directly at 800-447-0768 (TTY: 711). Our hours are 9 a.m. to 5 p.m., Monday to Friday.
Enrollment is voluntary and, if applicable, allows members to receive:
Program Components
The care management programs support practitioner care plans by using evidence-based clinical practice guidelines (CPGs) to highlight ways to prevent complications and flare-ups of chronic conditions. Clinical practice guidelines are updated regularly in Clinical Corner on emblemhealth.com. Check monthly for updates.
Key components include:
Note: For members with multiple chronic illnesses, or with severe or end-stage illness, patient preferences and needs should take precedence over guidelines-based care. Such members require highly individualized care plans and may not be suited for participation in some care management programs.
Tobacco-Free Quit-Smoking Program
EmblemHealth has partnered with the New York State Smokers Quitline (NYSSQL) to provide comprehensive smoking cessation services. NYSSQL is a state program based at the Roswell Park Cancer Institute in Buffalo, New York. The program is available at no cost to all New York State residents.
Services available through the NYSSQL include:
The Tobacco-Free Quit-Smoking Program is also implemented by Roswell Park. In addition to the NYSSQL benefits for New York residents, eligible EmblemHealth members ages 18 and older enrolled in the Tobacco-Free Quit-Smoking Program receive the following services:
Practitioners are encouraged to refer members directly to the New York State Smokers Quitline at 866-NY-QUITS (866-697-8487), or 311 in New York City. Referral forms can be found online at nysmokefree.com. For out-of-state members, referrals can be made directly to the program by calling 877-500-2393.
Studies show that a follow-up visit or phone call within one week of the patient's quit date can double the effectiveness of any intervention. EmblemHealth provides reimbursement for smoking-cessation counseling based on current Centers for Medicare & Medicaid Services guidelines. We reimburse for CPT codes 99406 and 99407.
Healthy Living Program
EmblemHealth provides many tools to help members manage their weight. Visit the Provider Weight Management Resources section of emblemhealth.com for information about:
Centers of Excellence (COE) Program
Select EmblemHealth members with serious injuries or illnesses related to cancer or orthopedics and musculoskeletal conditions have access to our industry-leading hospital partners, Memorial Sloan Kettering Cancer Center and Hospital for Special Surgery. EmblemHealth’s care management programs work collaboratively with the COE care teams to provide care coordination to address member needs.
EmblemHealth chose these Centers of Excellence partners after a competitive evaluation process because they are as committed as we are to meet the needs of our members. These top hospitals and doctors are nationally recognized for their high-quality, patient-focused care and best-in-class research, training, and technology standards. They have many convenient locations throughout Manhattan, Long Island, Westchester, and New Jersey.
Managing Entity Care Management Programs
SOMOS and HealthCare Partners (HCP) offer care management programs for EmblemHealth members who receive treatment under their care. For questions or more information about their care management programs, call:
Cityblock Care Management Program
Cityblock at 833-904-2273 (TTY:711), 24 hours a day, seven days a week.
The Care for the Family Caregiver initiative provides information, resources, and support to promote awareness and understanding of the key role of the family caregiver within the health care system. Through its programs, community outreach, and partnerships, Care for the Family Caregiver provides support and encouragement to family caregivers. For details, visit Care for the Family Caregiver.
EmblemHealth also hosts and sponsors the NYC Family Caregiver Coalition.