Care Management

The Care Management services uses a member/caregiver approach to promote availability of appropriate care and resources while maximizing the member’s quality of life and health care benefits. The assigned Case Manager works directly with the member and the family/caregiver(s) to develop an Individualized Care Plan (ICP) that is focused on increasing access to resources and services that support the member’s health needs. Our services are voluntary and are provided at no additional cost to the member.


Complex Case Management (CCM) is provided to members who have experienced a critical event or diagnosis that requires extensive use of resources and requires oversight to navigate the needed delivery of care and services. Case management becomes complex when the illness and/or conditions and complexity are severe and require an intense level of management beyond that of Case Management.


In addition to complex cases with co-morbid conditions and high utilization, the CCM team offers specialty focus areas including: 


  • Three or more acute hospital admissions per year.
  • Two or more emergency department visits in a six-month period. 
  • Complex medical needs that require close monitoring, including but not limited to transplant, transgender, high-risk OB, high-risk pediatrics.
  • Behavioral health conditions, including but not limited to depression, substance abuse, anxiety, autism, severe mental health illness, and maternal mental health.
  • Life expectancy of six months or less.
  • Complex psychosocial or functional requirements.


Disease Management Programs

Scripps Health Plan also offers additional information, programs and guidelines on managing certain diseases or conditions:



Our nurses and the provider will offer additional support, helping the member understand what the condition means to the member’s everyday life. We can also provide contact information for Community Resources that will help educate the member and their family on how to stay on top of their condition and manage their health. 


Specific care and treatment may vary depending on individual need and the benefits covered under your contract.


Maternity Program helps our patients:


  • Coordinate care to help manage a pregnancy.
  • Get specialized care if you have a high-risk pregnancy.
  • Prepare for a new baby.
  • Support and coordinate your postpartum care.
  • Offer support if you are dealing with a pregnancy loss.
  • Manage family planning decisions.
  • Learn about breastfeeding and resources.
  • Provide a recommendation for doula services.

Scripps Health Plan offers doula services as part of our efforts to improve access to pregnancy care. Our goal is a healthy outcome for parent and baby. One of the other key aspects of a doula is to ensure mother and baby are supported in the social conditions that may affect their overall health or their social determinants of health. Continuous doula support during the pregnancy journey may lead to improved health outcomes and offer additional social, emotional, and physical supports for the pregnant and birthing person. Studies have demonstrated that support from non-clinical providers, such as doulas, is associated with lower cesarean rates, fewer obstetric interventions, fewer complications, lower use of pain medication, shorter labor, higher rates of breastfeeding and higher scores on the Apgar test.


With a referral, our members are eligible for the following doula services:


  • One (1) initial visit with your doula.
  • Up to eight (8) additional visits; these can be a combination of prenatal and postpartum visits.
  • Support during labor and delivery (including labor and delivery resulting in a stillbirth), abortion or miscarriage.
  • Up to two (2) three-hour postpartum visits.


Members can get doula services up to 12 months after the end of pregnancy.


Maternal Mental Health law, as described in California SB 1207 and the Health and Safety Code (Section 1367.625) requires that a licensed health care practitioner (provider) who provides prenatal or postpartum care for a patient shall ensure that all mothers are offered screening or is appropriately screened for maternal mental health conditions. 


Members with a positive screening can be referred to the Magellan Health Network of providers and/or be referred to our Care Management Program, which is designed to assist with healthcare needs, care coordination, making appointments and connecting members with community resources. 


Did you know that anyone can make a referral to our Care Management Program. Referrals can be made via:


Note: Our case management, disease management and maternity programs are voluntary, and the member may opt out at any time by calling 888-399-5678. 


Preventive Health & Wellness

Free benefits for our patients that make a difference.


Our patient’s health is our top priority. We encourage our practitioners to recommend our patient’s take advantage of the many preventive care services that are available to them at no additional charge when scheduled with an in-network provider.



Wellness tips and resources

You also have access to the wellness solution library by clicking on the link below.


The wellness solution library includes decision making aids that provide information about treatment options and outcomes. We encourage you to use these decision-making aids during the treatment decision process, including during discussions with your patients. 


Pharmacy management

Scripps Health Plan provides coverage for all medically necessary outpatient prescription drugs. Scripps Health Plan utilizes a formulary to define preferred drugs and requires prior authorization for all non-preferred drugs. Prescription drugs may only be prescribed by licensed physicians, licensed physician assistants, licensed nurse practitioners, dentists and licensed behavioral health practitioners in accordance with their credentials and licensure. Prescriptions should be written to allow generic substitution whenever possible and signatures on prescriptions should be legible, and electronically submitted when possible.


The Scripps Health Plan Prescription Drug Plan is managed by MedImpact, a trusted Pharmacy Benefits Manager (PBM). For inquiries related to your patient’s pharmacy benefit or prior authorization requirements, please call MedImpact customer contact center at 844-282-5343. MedImpact is available 24 hours a day, 7 days a week.


To locate a participating pharmacy, search the MedImpact Pharmacy Locator.

Pharmacy Locator


Mailing address

MedImpact

10181 Scripps Gateway Ct.

San Diego, CA 92131

844-282-5343

TTY: 711


90-days’ supply of medications may be filled by MedImpact Choice90 network pharmacies or Scripps Outpatient Pharmacies. Information about the mail order program is available through Scripps Outpatient Pharmacies and by using the Scripps Health Ambulatory Pharmacy Medication Order Form (PDF, 150 KB) and fax it along with the prescriptions to 619-686-3932. Call 858-964-1013 if you have any questions. 


Specialty pharmacy


Specialty medications are used to treat chronic and complex conditions and usually require particular medications for that condition. Specialty medications are more complex and are often used to treat conditions such as cancer, hepatitis C, hemophilia, multiple sclerosis, HIV and rheumatoid arthritis.


Scripps Health Plan members may receive specialty medications through Scripps Outpatient Pharmacy or through MedImpact Direct Specialty.


For specialty medication services through Scripps Outpatient Pharmacy, contact:


Scripps Green Outpatient Pharmacy

Phone: 858-964-1101

Fax: 858-554-2544


For specialty medication services through MedImpact Direct Specialty, contact:


MedImpact Direct Specialty 

8150 S. Kyrene Road, First Floor

Phoenix, AZ 85284

Phone number: 877-391-1103

Fax number: 888-807-5716

Email: specialtyhub@medimpactdirect.com