Page 126 - 2021 Medical Plan SPD

Texas Mutual Insurance Company Medical Plan

Clinical Programs and Resources

Care Management

Care Management Solutions

Personal Health Support

The Claims Administrator provides a program called Personal Health Support designed to encourage
personalized, efficient care for you and your covered Dependents.
Personal Health Support Nurses center their efforts on prevention, education, and closing any gaps in
your care. The goal of the program is to ensure you receive the most appropriate and cost-effective
services available.

If you are living with a chronic condition or dealing with complex health care needs, the Claims
Administrator may assign to you a primary nurse, referred to as a Personal Health Support Nurse, to
guide you through your treatment. This assigned nurse will answer questions, explain options, identify
your needs, and may refer you to specialized care programs. The Personal Health Support Nurse will
provide you with their telephone number so you can call them with questions about your conditions, or
your overall health and well-being.

Personal Health Support Nurses will provide a variety of different services to help you and your covered
family members receive appropriate medical care. Program components are subject to change without
notice. When the Claims Administrator is called as required, they will work with you to implement the
Personal Health Support process and to provide you with information about additional services that are
available to you, such as disease management programs, health education, and patient advocacy. As of
the publication of this SPD, the Personal Health Support program includes:
• Admission counseling - Nurse Advocates are available to help you prepare for a successful
surgical admission and recovery. Call the number on your ID card for support.
• Inpatient care management - If you are hospitalized, a nurse will work with your Physician to
make sure you are getting the care you need and that your Physician's treatment plan is being
carried out effectively.
• Readmission Management - This program serves as a bridge between the Hospital and your
home if you are at high risk of being readmitted. After leaving the Hospital, if you have a certain
chronic or complex condition, you may receive a phone call from a Personal Health Support
Nurse to confirm that medications, needed equipment, or follow-up services are in place. The
Personal Health Support Nurse will also share important health care information, reiterate and
reinforce discharge instructions, and support a safe transition home.
• Risk Management - Designed for participants with certain chronic or complex conditions, this
program addresses such health care needs as access to medical specialists, medication
information, and coordination of equipment and supplies. Participants may receive a phone call
from a Personal Health Support Nurse to discuss and share important health care information
related to the participant's specific chronic or complex condition.
• Cancer Management - You have the opportunity to engage with a nurse that specializes in cancer,
education and guidance throughout your care path.
• Kidney Management - You have the opportunity to engage with a nurse that specializes in kidney
disease, education and guidance with CKD stage 4/5 or ESRD throughout your care path.

123 Clinical Programs and Resources