Care Management

San Francisco Health Plan’s (SFHP) Care Management programs are here to partner with you and your SFHP patients. Our multidisciplinary team works with SFHP members both in person and over the phone. Our process includes conducting a comprehensive assessment of the member’s needs, determining available benefits and resources, and developing and implementing a patient centered care management plan with goals, monitoring and follow-up.

The primary goals of our Care Management programs are to:

• Provide support and advocacy for patient and provider
• Meet the members in the community
• Coordinate and refer to transportation resources as appropriate
• Decrease fragmentation of care and endorse a holistic member view
• Promote wellness and connect to community resources
• Improve patient and provider satisfaction
• Improve health outcomes
• Connect members to SFHP incentive programs as appropriate
• Facilitate safe transitions between different levels of care

We have a variety of programs with different focus areas to address the needs of many subpopulations seen within SFHP’s membership.

For Medi-Cal Members:

• Program for members in need of chronic condition management or experiencing a significant change to their physical or cognitive functioning
• Members with short-term needs related to navigating the health care system or connecting to community resources
• Child and adolescent members ages 0-17 experiencing barriers to care or needing support navigating the health care system
• Members aging out of California Children’s Services (CCS) at age 21 who need support transitioning their specialty care and services to SFHP coverage
• New members who are Seniors and/or Persons with Disabilities
• Members who meet the criteria for Enhanced Care Management as defined by the Department of Health Care Services. This includes high utilizers, adults with Serious Mental Illness / Substance Use Disorder, and individuals and families experiencing homelessness with complex physical/behavioral/or developmental health need and the inability to successfully self-manage.

For SFHP Care Plus (D-SNP) Members:

• Every SFHP Care Plus member is paired with a dedicated Care Manager, their primary point of contact and trusted resource throughout their membership. The Care Manager collaborates closely with the member and their care team to:
• Coordinate personalized care
• Connect members to resources
• Support progress towards individual health goals
• Members eligible for California Integrated Care Management (CICM), as defined by the Department of Health Care Services include individuals with documented dementia needs, high utilizers, adults with Serious Mental Illness / Substance Use Disorder, and individuals and families experiencing homelessness with complex physical/behavioral/or developmental health need and the inability to successfully self-manage. Please visit SFHP’s library of health education materials that cover a wide range of health and wellness topics. Feel free to print them and share with your colleagues and patients. Please see the Service Directory for a list of local community resources that may be helpful for your members.

If you believe your patient would benefit from our services, either you or your patient can call our intake line at 1(415) 615-4515 for Medi-Cal members or 1(415) 615-4545 for SFHP Care Plus (D-SNP) members or email us at [email protected] to connect with a member of our team. If our SFHP team is unable to serve your member we will do our best to connect them to a program with one of our delegated medical groups or community partners.