HAP care management gives members with chronic or complex conditions a case manager to coordinate their care.
HAP describes its care management program as a collaborative process of assessment, planning and care coordination. The member page does not state a line of business, so employers should confirm availability for their group.
What the program is and what members do.
What the program is
HAP describes care management as assessment, planning, help with barriers to care, care coordination, member education, and advocacy for services. HAP says it promotes patient safety, quality of care and cost-effective outcomes. The aim, as HAP states it, is to help members understand and manage their conditions.
How members use it
HAP says members can call or email the care management team to enroll. A doctor, family member or caregiver can also send a referral by email. HAP says the work includes a plan built around each person’s goals, work with the member’s doctor, and monitoring of progress.
What it covers or does not
HAP says the focus includes support as members move between care settings, such as hospital back to home. It says services may include a behavioral health specialist. HAP says the program is free to the member. The page does not set out clinical criteria for who is accepted.
Eligibility, funding and plan design.
Who can use it
HAP’s page describes people with chronic and complex conditions who may need many providers, prescriptions and appointments. It does not define eligibility criteria and does not state a line of business. The page carries a Medicare tag on the site, so employers should not assume it applies to a commercial or self-funded group without asking HAP.
How it is funded or sold
HAP says the program is free to members. The page describes no employer fee. Ask HAP whether it is built into the group’s administrative cost or rate.
Where it fits in plan design
It sits beside the medical plan as a service for members with higher needs, and it works together with transitional care and condition programs. For an employer, it is most useful as a named contact for employees who are overwhelmed by a serious diagnosis.
What to settle before relying on it.
Does this program apply to our line of business?
The page does not name one. We would ask HAP to confirm in writing that members of our group can use it, and to name the team that serves commercial or self-funded members.
How are members identified and referred?
HAP lists self-enrollment and referral by a doctor, family member or caregiver. We would ask whether HAP also reaches out proactively using claims data, and how that outreach is explained to employees.
What does HAP report back to the employer?
We would ask what, if anything, HAP reports at the group level about participation, and how member privacy is protected, so we can set realistic expectations in communications.
Common questions about this program.
Is HAP care management free?
HAP’s page says the program is free to members. It does not describe how it is funded for an employer group.
Can a family member refer someone?
HAP says a doctor, family member or caregiver can send a referral by email to the care management team.
Is it available to commercial and self-funded groups?
The page does not state a line of business and carries a Medicare tag on the site. Confirm availability with HAP for your group.
Where these details come from.
This page summarizes what HAP publishes. Programs change, so confirm current details with the carrier before relying on them.
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