Medical Management

Health Choice Utah uses advanced technology to improve the healthcare experience of members through a sophisticated care management platform that:

  • Provides health risk assessments for all plan members encompassing medical, psychosocial, cognitive and functional measures.
  • Identifies members who can benefit from case management and disease management.
  • Facilitates collaboration between interdisciplinary care teams to better manage members’ care plans.
  • Facilitates the evaluation of care effectiveness.
  • Meets stringent care management requirements for CMS and Medicaid.
  • Our care management platform gives providers additional tools to assist patient care, including:
  • Submission of web-based authorization requests.
  • Review status of authorization and referral requests.
  • Ability to request case management enrollment.

Health Risk Assessment

All new members of Health Choice Utah are given a health risk assessment that evaluates several factors, including medical, psychosocial, cognitive and functional measures. After the initial assessment, if a risk is identified, the member is offered and encouraged to enroll in a specialized healthcare management program which is designed with individualized care plans for achieving healthcare goals.

Additionally, our care management platform gives our team of qualified case managers, care coordinators and medical professionals the ability to monitor and identify patients whose health status has changed and may benefit from disease and/or care coordination.

Care Management

Our comprehensive disease and case management programs are designed to improve the quality of life for members with chronic diseases and complex conditions. Programs include:

  • Asthma –The goal of the Asthma Program is to improve the quality of life for qualifying members age five years or older.
  • Diabetic – The Diabetic Program is designed to improve HbA1c testing and levels among diabetic members. Members will also increase disease awareness and self-management of their medical condition(s).
  • Hepatitis C – This program was developed to improve medication adherence for members diagnosed with Hepatitis C and to improve overall compliance with the member’s care plan.
  • Complex Case Management – The Complex Case Management Program is designed to provide high quality case management to members with multiple and/or complex, and/or catastrophic injuries, the frail and elderly, members in Special Needs Plans (SNP) and other members with high risk health conditions.

Transition of Care Program

Our Transition of Care Program is unique to the industry. Once any of our members has been identified as newly enrolled in Medicaid, or has had a transition change (which may include an admission to or a discharge from a hospital facility), the care coordination team at Health Choice Utah immediately initiates a transition of care plan.

A care coordinator first contacts the member and performs a health risk assessment which can include medical, psychosocial, cognitive and functional review. The results of the assessment help guide care coordination and case management, and lead to a detailed, interdisciplinary care plan.

The care plan can include several components, such as comprehensive discharge planning, medication reconciliation, coordination with behavioral health providers, assistance with home-based services and follow-up appointments.

Stork Program

Pregnant women can register for our Stork Program to receive information and guidance from our maternity nurses to help them have a healthy pregnancy. Our Stork Program will also help pregnant women and new moms obtain the community resources they need for their family.

Healthy Kids & Families

At Health Choice Utah our goal is to keep you and your children healthy. We believe that a healthy start in life will allow them to have a bright future! The Healthy Start, Bright Futures children’s campaign focuses on six pillars for a healthy life:

  • Annual well visits
  • Immunizations
  • Dental visits
  • Education
  • Exercise
  • Nutrition

For more information about care management at Health Choice Utah, call 1-877-358-8797 or click here.

For information about the Stork Program, call (877) 358-8797 or click here.


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