McLaren says its care management program is open to all members and is especially aimed at members with complex health needs.
McLaren describes care management as nurse led support that coordinates care for members with complex needs. Employers should confirm it applies to their group.
What the program is and what members do.
What the program is
McLaren describes a Care Management program that helps members get the care and services they need. The carrier says it includes frequent contacts from a McLaren nurse and a care plan with short and long term goals.
How members use it
The carrier says a McLaren nurse may ask a member to join, a doctor may suggest it, or the member can ask by calling 888-327-0671 (TTY: 711) and asking for a nurse.
What it covers or does not
The page describes care coordination with the member and their doctor. It states no costs and lists no specific services paid for, so it is a coordination service and not a benefit.
Eligibility, funding and plan design.
Who can use it
McLaren says care management is available to all members and is especially helpful for those with many difficult health problems. Its list includes a serious long term problem, repeated hospital or urgent care visits, many medicines, needed equipment or supplies, serious injuries and an organ transplant need. The page does not state a line of business (Medicaid, Medicare or commercial). Employers should confirm with McLaren that it applies to their group.
How it is funded or sold
The page states no price or fee. It reads as a plan service available to members.
Where it fits in plan design
Care management is the layer that touches high cost, high need members across conditions. Employers with a few complex claimants may care about it most, but the page gives no results data.
What to settle before relying on it.
How do members get referred?
The page names the nurse, the doctor and the member as ways in. We would ask what claims data triggers outreach and whether employers or brokers can request a referral.
How much privacy and employer visibility is there?
The page describes nothing about employer reporting. We would ask what, if anything, McLaren shares at the group level.
Does it apply to our group?
The page does not state a line of business. We would ask McLaren to confirm eligibility for our group in writing.
Common questions about this program.
Who can use care management?
McLaren says it is available to all members and is especially helpful for those with many difficult health problems.
How does a member join?
The carrier says a nurse or doctor may suggest it, or the member can call 888-327-0671 and ask for a nurse.
Does this apply to my employer group?
The page does not state a line of business. Employers should ask McLaren to confirm applicability.
Where these details come from.
This page summarizes what McLaren publishes. Programs change, so confirm current details with the carrier before relying on them.
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