Care management programs 

For members with acute, chronic, or complex health conditions, Fallon Health’s care management programs may help you improve your quality of life and your health. These programs are free of charge, and you can choose to participate or not at any time―it won't affect your benefits.

What are acute, chronic, and complex health conditions? 

Acute health conditions are short-term conditions. They come on suddenly and don’t last long (a few days to several weeks). Examples include colds, viruses, infections, or injuries. 

Chronic health conditions develop gradually, last for months or years, and may get worse over time. Examples include asthma, cardiac conditions, congestive heart failure, COPD, and diabetes.

Complex health conditions consist of more than 1 health condition—chronic and/or acute —and require multiple types of care or care providers.  

Programs for members with acute health conditions

  • Case Management is provided by our team of registered nurse case managers, who will teach you about your conditions and work with your medical providers to make sure you’re getting the services you need.
  • Care Coordination is provided by our team of Navigators, who will teach you about your health plan benefits and help you find community resources, like transportation to facilities, and other benefits available in your plan.
  • Social Care Management is provided by our team of social care managers, who will work with you to find the resources and help you need.

Programs for members with chronic health conditions

Chronic disease management programs are available for those who have asthma, cardiac conditions, congestive heart failure, COPD, and diabetes.

Our team of health educators and nurses will work closely with you over the phone to help you manage the challenges of your health condition. They'll:

  • Help you learn more about your condition
  • Give you information about online resources and local programs
  • Provide you with educational materials about living well with your condition
  • Arrange for equipment if you need it

Program for members with complex conditions

Case Management is provided by our team of registered nurse case managers, who will teach you about your conditions. They work with your medical providers to develop and implement a plan to meet your personal health goals.

Learn more

To learn more about our programs and how you can participate, call us at: 1-508-799-2100, ext. 78002, Monday through Friday from 8:30 a.m. to 5:00 p.m. 

 

NaviCare is a voluntary program in association with MassHealth/EOHHS and CMS.

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The information on this page was last updated on 10/1/2024.