NEMS Care Coordination & Case Management Program

NEMS offers comprehensive Care Coordination and Case Management services for our members. Our Nurse Case Managers and Health Services Care Coordinators work collaboratively to coordinate community-based interventions that address the member’s medical, social, and behavioral health needs. The care team works closely with the member, their family, and their healthcare providers to facilitate care transitions and linkages to community support services. The care team considers cultural factors, environmental factors, and functional impairments that may affect the member’s health when providing care planning and coordination.

The NEMS Care Coordination and Case Management Program goals are:

  • To empower members to manage their own medical conditions, have a better understanding of their medications, and get connected to community resources.
  • To improve member outcomes by coordinating services in physical health, mental health, substance use disorder, community-based Long-Term Support Services (LTSS), palliative care, and social support.
  • To measure member satisfaction and incorporate feedback into the program’s quality improvement process.
  • To reduce avoidable health care costs, such as hospital admissions/readmissions, emergency department (ED) visits, and nursing facility stays.

If you feel you or a family member would benefit from the NEMS Care Coordination and Case Management service, please call our Case Management Hotline at 415-352-5179, Monday to Friday, 8:00 a.m. to 5:30 p.m., and speak with a member of our team. This service is at no cost to all NEMS members.

The Health Homes Program (HHP) is a federally funded program designed to improve the health outcomes of qualified Medi-Cal members with certain chronic conditions and complex medical needs. NEMS is a Community-Based Care Management Entity (CB-CME) that provides extensive care coordination services at no cost to members in San Francisco & Santa Clara County.

The Health Homes Program (HHP) can help members with the following:

  • Comprehensive assessment and person-centered care planning
  • Coordination of appointments, transportations, medication refills, interpretations, etc.
  • Health Promotion to encourage lifestyle choices based on healthy behavior
  • Comprehensive transitional care to foster a smooth discharge planning
  • Individual and family support services
  • Referral to community and social supports
  • Housing navigation

HHP services are provided by a multidisciplinary team, which includes physicians, specialists, pharmacists, nurses, health educators, community social workers, nurse case managers, care coordinators, and more.

Each HHP enrolled member is assigned a Nurse Case Manager and a Care Coordinator. The NEMS HHP multidisciplinary care team will work with providers and vendors to coordinate HHP activities and to ensure members’ health care needs are met.

Click here to learn more about the NEMS Health Homes Program (HHP).

The Medicare Chronic Care Management (CCM) program focuses on managing chronic care and preventive care services for Medicare members with multiple chronic medical conditions. The CCM program provides each member personalized and connected care to help the individual better manage their health. CCM services may include:

  • A personalized care plan
  • Assistance from a dedicated health care team who will work with each member to meet their health goals
  • Regular follow-up to help the individual keep track of their health care needs
  • Coordinate care between doctors, pharmacies, hospitals, skilled nursing facilities, and more

CCM services are provided by a multidisciplinary team, which includes physicians, pharmacists, nurse case managers, patient health coaches, care coordinators, and more.

Click here to learn more about the Chronic Care Management (CCM) program.