Care Management For Physicians and Providers

PHP has put together a team to personally support you, your practice, and your patients. Each physician has enhanced accessibility to a team of nurses, social workers, triage coordinators, and referral specialists. You may contact the PHP Care Management department by calling:

303.605.1530

• Option 1 – Prior Authorization
• Option 2 – Facility and Intensive Resource Management

The following triggers will activate the care team for any patient across the continuum:

• Psychosocial issues, such as decreased social support, financial needs, Alzheimer’s/Dementia
• Diabetes, COPD, or CHF
• Patients with complex acute and skilled facility discharge planning needs
• Requests directly from the PCP offices for a Care Manager

If you have a patient who you believe could benefit from assistance from a Care Manager, please contact 303.605.1530, and select Option 2.

To support you, your office, and patients, PHP offers the following services:

For more detailed information please see “Provider Relations Manual”

Prior-authorization

Physician Health Partners reviews requests for prior-authorization of services on behalf of our contracted physicians for certain health plans. The Care Management Prior-authorization department utilizes health plan and Medicare guidelines, as well as Milliman Care Guidelines to evaluate if services are covered benefits under the member’s health plan, are medically appropriate, and are being performed at the correct level of care. Physicians contracted with Physician Health Partners (PHP) submit requests for specialty physician referrals directly to PHP. PHP assists contracted physicians in directing care to PHP-contracted providers whenever possible to maintain quality, cost effective care for all their patients.

Prior-authorization requests can be submitted online through MCS, an internet-based secure application available to participating providers to expedite the authorization process

Facility Management

A PHP Care Manager helps to coordinate care while your patient is in the hospital by:

• Monitor patient’s daily progress
• Coordinate with the hospital physician to assure the member has the right care at the right time
• Participate with member, family, and the hospital staff to plan for discharge
• Facilitate authorizations for the services needed when leaving the hospital

Triage Coordinator Role

• Contact all patients who have had special home services ordered upon discharge to ensure those services are taking place as ordered
• Assure you have the proper resources in place to succeed at home, such as transportation to all follow-up appointments
• Respond to inbound calls from physician offices, patients, and families, and route referrals to the appropriate Care Manager

Direct Admit to SNF

PHP Care Managers are available to help you with the process of admitting a patient directly to a skilled nursing without the need for a hospital stay or emergency room visit.

Please click here for quick guide.
Please click here for skilled nursing facility admit orders.

Personal Health Picture

PHP has utilized the Personal Health Record developed by Eric Coleman, MD, MPH (www.caretransitions.org), and has designed a Personal Health Picture for patients. Patient with the triggers listed above receive a Personal Health Picture. A PHP Care Manager will visit with the patient in their home or facility to assist the patient in completing their Personal Health Picture. The Personal Health Picture is a tool to assist patients, families, and their healthcare team to organize their past and current health issues, including conditions, medications, advanced directives, immunizations, hospitalizations, and more. Patients who receive a Personal Health Picture are encouraged to bring it to all their healthcare appointments and hospitalizations.

Please click here for an example of a Personal Health Picture.

Please contact PHP’s Care Management department at:

303.605.1530

• Option 1 – Prior Authorization
• Option 2 – Facility and Intensive Resource Management