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Home > Providers > Provider Communications > Keys To Your Care

Keys To Your Care: A Member Health Education & Management Program

Keystone Mercy Health Plan is pleased to announce the launch of a member health education and management program: Keys to Your Care. This proactive medical care coordination program focuses on Keystone Mercy members with specific health risks.

Based upon the illness and the severity of illness of your members, you may be contacted to refer Keystone Mercy patients to us for participation in one or more of the Keys to Your Care programs. These programs are intended to be a collaborative arrangement between our Case Managers and your existing treatment plans for the involved members and will in no way impede on your autonomy to provide care to members enrolled in the following programs.

Pediatric Preventive Care

This program provides the following services for members under two years of age:

Outreach calls for age appropriate EPSDT services
Outreach calls by Case Managers to members with children under age 1 who have no history of immunizations
Annual birthday card reminders for all EPSDT services
Identification of children with elevated lead levels to ensure ongoing care is received
Coordination of specialty care referrals and services for children with serious medical needs

All other EPSDT members (age 2-20) are eligible for all other EPSDT related services, including annual birthday card reminders for all EPSDT services due. For more information, please contact our Pediatric Preventive Care Liaison at 1-800-521-6007.

Pregnancy Management

This pregnancy management program is called WeeCare Baby Benefits and separates pregnant Keystone Mercy members into low and high intensity risk categories with the following goals:

Low Risk Pregnancy Management. Members will receive pregnancy-related educational materials encouraging good prenatal care.
High Risk Pregnancy Management. Pregnant members identified at risk for preterm labor and/or other pregnancy complications will be assigned a nurse case manager to provide ongoing supervision and education about pregnancy. A letter will be sent to the member's physician to notify him/her of the member's enrollment in the program with a summary of the initial assessment

All pregnant Keystone Mercy members have access to a 24-hour toll free registered nurse call line at 866-405-7946. For more information or to refer members to our pregnancy management program please call 1-800-521-6007.

Special Needs Case Management

This program addresses the needs of members who self-identify or who have special medical requirements or risk factors that are identified through physicians, case managers, etc. Special Needs Case Management is not disease specific. For more information or to refer your patients with Special Needs call 1-800-521-6007.

Disease Management

Healthy Returns is a voluntary program focused on prevention, education, lifestyle choices and adherence to treatment plans. Healthy Returns is designed to support your plan of care for patients with the following diseases:

Members will receive educational materials and, if identified as high risk, will be assigned to a Case Manager for one-on-one education and follow-up. For more information or to refer a patient to our Healthy Returns Program, call 1-800-521-6007.

Keystone Mercy also provides disease management services to members with the following diagnosis:

Members in this program are assigned to a Disease Management Nurse who provides education and assistance with obtaining medications and specialty referrals. For more information or to refer a member to the HIV, Sickle Cell or Hemophilia program, call 1-800-521-6007.

Intensive Case Management

This program is designed for Keystone Mercy members with multiple chronic illnesses who require complex case management for coordination of all aspects of care and services. Members will be assigned to a case manager that will assist in coordinating all aspects of care such as ensuring access to appointments and resolving transportation, pharmacy and equipment issues. The case manager will make scheduled telephone calls to ensure the member is following the plan of care. Due to overwhelming need, this program is currently at capacity. If you wish to refer a member to the waiting list please call 1-800-521-6007.

Keystone Mercy is enthusiastic about the potential for positive health outcomes resulting from this new focus on prevention, education, and adherence to treatment plans. With your identification of members and consequent referrals to the programs listed above we can assure Keystone Mercy members are receiving appropriate levels of care.

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medicaid managed care, Pennsylvania, Philadelphia, Medicare Coverage, Find a Medicaid Health Insurance Plan, Find a Medicaid Provider, Doctor, Pharmacy, Pharmacist, What is Medicaid, How much does it cost to sign up for Medicaid, What is Medicaid Managed Care, How does Medicaid Managed Care Work?

Medicaid Managed Care Health Insurance, What is Medicaid, How do I sign up for Medicaid?

Medicaid Care, Managed Care or Medicaid, Manager, Manage Management of Care, and how to get health care. hospitals that accept Medicaid Managed Care patients

Find a Doctor in Pennsylvania, Find a Hospital in Pennsylvania, Who accepts Medicaid Managed Care

Healthcare Providers Pennsylvania, Medicaid Managed Care

Keys To Your Care: A Member Health Education & Management Program