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Pennsylvania

Community to Home Program

Created in 2019, the Community to Home Program provides community health case management and resources to Children With Special Healthcare Needs (CSHCN) and their families in rural Pennsylvania. Our Community Health Workers provide intense case management for a six-month period to assist with activities for educational, medical, mental health, fiscal, community resource and independent living needs to promote family self-sufficiency. CareStar partners with the Pennsylvania Department of Health to provide the services for this Program.

Populations Served: CSHCN and their families served through this Program must reside in rural regions of Pennsylvania, must meet the 300% poverty level of income threshold and be newly diagnosed with a qualifying diagnosis or new to their region within the last year.

Location: CareStar has been awarded five (5) regions serving the Northeast, Northeast Central, Northwest, Northwest Central and the Southwest regions of the State. These five (5) regions are made up of 40 counties throughout the State.

Application Process: To be enrolled for Program services, eligible children/families complete a referral form and send it to CareStar via email, fax, mail or phone call. Once the referral is received, CareStar conducts a telephonic eligibility assessment. When the individual is eligible, a Community Health Worker conducts an assessment within 48 hours. Once the assessment is completed, the Community Health Worker collaborates with the individual to create a person-centered service plan to use as a blueprint for the individual to create and achieve goals identified in the assessment process. The individual/family will work with the Community Health Worker for a period of six (6) months to achieve goal completion and to gain self-sufficiency moving forward.

External Resources: CareStar has contacted over 20 agencies and social service programs to outreach the community and market the new Program. These agencies and programs will serve as partnering businesses/agencies to spread the word and provide referrals for the Program. The Special Kids Network Hotline is also another avenue through the State Health Department that will provide referrals for the Program. The Parent Education and Advisory Leadership (PEAL) Center is also a vital program that has partnered with CareStar to work as an advocate for this Program.

Specialty Care – Sickle Cell Disease Community-Based Support Program

CareStar and the Pennsylvania Department of Health have partnered on their Specialty Care Program (SCP), which provides services and supports for people living with beta thalassemia (Cooley’s Anemia), Cystic Fibrosis, hemophilia, sickle cell disease (SCD), spina bifida and neuromuscular and orthopedic conditions. CareStar’s role in this Program is to ensure individuals diagnosed with these conditions are able to lead as healthy and productive lives as possible, through enhanced communication and service provision across healthcare systems and providers, as well as equitable access to these services. For additional information on SCD and CareStar’s SCD program follow this link for a PowerPoint presentation.

Populations Served: CareStar serves individuals living with beta thalassemia (Cooley’s Anemia), cystic fibrosis, hemophilia, sickle cell disease (SCD), spina bifida and neuromuscular and orthopedic conditions.

Location: CareStar has been awarded two (2) regions of Pennsylvania serving the Northwest and the Southeast regions of the State. These two (2) regions are made up of 27 counties throughout the State, including the cities of Erie and Philadelphia.

Application Process: Individuals looking to apply for the SCD Community-Based Support Program can either be self-referred, if over the age of 18, or be referred from an establishment. A referral form must be completed and sent to SCPA@carestar.com. The Program Supervisor will then review the form and reach out to the individual to complete an eligibility assessment. Once accepted into the SCD Program, a community health worker (CHW) will be assigned to the individual. The CHW will contact the individual and create a unified care plan with tasks and steps to complete each goal created. The CHW will then partner with the individual on  attending appointments, creating roadmaps to self-sufficiency, family interaction, medical care navigation, and mental health support.

Population Health – Health Risk Assessments (HRA)

CareStar has partnered with Managed Care Plans to complete telephonic and in-person Health Risk Assessments, Health Needs Assessments and care planning for eligible members. CareStar completes the assessments to gather updated health history and to determine if there are any identified health or social service needs. Risks identified for the individual during the assessment are reported for additional care management follow-up. CareStar is committed to helping identify an individual’s needs and providing resources when necessary.

Population Served: Members of a managed care plan or other medical insurance provider.

Location: CareStar can perform these services where members reside or telephonically.

Multiple Sclerosis Society Case Management

Since 2016, CareStar has partnered with the National Multiple Sclerosis Society to provide Case Management and Assessment services to eligible individuals. The goal of the partnership is to help individuals living with and managing their Multiple Sclerosis, set goals for and receive appropriate care, support, and safety to improve their independence and quality of life. For each individual, CareStar will perform an initial assessment, develop a person-centered care plan, link the individual with caregivers and resources, and follow-up to ensure the plan is being executed and accomplished.

Populations Served: CareStar serves individuals of all ages, who have been diagnosed with Multiple Sclerosis and who the MS Society’s Case Management Program deem eligible.

Location: CareStar can perform services, both telephonically and in-person, across the United States.

Application Process: If you, or a family member, has been diagnosed with MS and believe could benefit from CareStar’s Case Management services, please contact an MS Navigator by calling 1-800-344-4867 and request to work with CareStar. If the Case Management Program eligibility and criteria has been met, the MS Society will refer the applicant to an authorized Case Management Agency (CMA). The CMA will contact the applicant to schedule and complete the assessment, develop goals, and develop a person-centered care plan.

Quality and Utilization Review

CareStar is proud to be Quality Improvement Organization-like (QIO-like) certified by the Centers for Medicare and Medicaid Services (CMS). As a leader in Case Management, Assessment, Technology and Software Development, CareStar uses this Certification to assist our customers with quality assurance, improved healthcare outcomes and reduced costs. Additionally, CareStar engages physicians in specialty areas including, but not limited to, Family Medicine, Cardiology, Pulmonology, Gastroenterology, Neurology, Vascular Surgery, Internal Medicine, and Cardiovascular and Thoracic Surgery, to expand our expertise and capabilities and ensure efficiency and accuracy of our QIO-like activities.

Administered by CMS, a QIO-like Organization is made up of a group of expert healthcare clinicians and professionals contracted to complete utilization reviews and analyze patterns of care related to medical necessity and quality review. State Medicaid Agencies and organizations contracting with CareStar for QIO-like services are eligible for an enhanced Federal match of funds up to 75 percent. The QIO-like Certification is one of CMS’s most significant programs to improve quality and efficiency of healthcare delivery. As of March 2020, CareStar is one of 76 organizations to hold this certification nationally