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.

Enhanced Care Management, or ECM, is California’s first statewide effort to address complex care management. ECM is a new care coordination benefit under the Medi-Cal program and is available to “populations of focus” including:

  • Homeless Adults and Families
  • High Utilizers with Frequent Emergency Department and Hospital Admissions
  • Adults with Severe Mental Illness and Substance Use Disorder
  • Individuals Transitioning from Incarceration
  • Individuals at Risk for Institutionalization and Eligible for Long Term Care Services
  • Children and Youth
  • Nursing Facility Residents Who Want to Transition to the Community

Enhanced Care Management will address clinical and non-clinical needs of the highest-need enrollees through intensive coordination of health and health-related services. ECM core services include:

  • Outreach and Engagement
  • Comprehensive Assessment & Care Management Plan
  • Enhanced Coordination of Care
  • Health Promotion
  • Comprehensive Transitional Care
  • Member and Family Supports
  • Referral & Coordination of Community & Social Support Services

NEMS provides ECM services at no cost to enrollees in San Francisco and Santa Clara Counties. Enrollees will have a single Enhanced Care Manager who will coordinate care and services among the physical, behavioral, dental, developmental, and social services delivery systems, making it easier for them to get the right care at the right time.

Click here to learn more about NEMS Enhanced Care Management (ECM).

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.