Care Transitions


With Highmark Wholecare, your care doesn't end when you leave the doctor's office.

Embedded Care:
Somebody You Can Count On

We place care managers where a high volume of Highmark Wholecare members seek assistance. That way, somebody you can count on is always close by. They can help arrange transportation to and from doctor visits and inform you about community services that may help you.


Transition Care:
Home, Hospital and Everywhere In Between

We are here to help you at all times. Soon after leaving the hospital, one of our Transition Care Managers will check in to see how you're recovering. They are a great resource for setting up follow-up appointments and closing up any gaps in care that may arise.


Complex Care:
The Quality of Care You Need

We provide a Complex Case Management program for eligible members. A Care Manager can help you to better understand your health condition and benefits and can also help to coordinate your health care services by talking with your doctor. We can also tell you about community organizations and resources that may meet your needs.

You may be eligible for the Complex Care Program if you are a Highmark Wholecare Member and you:

  • Have multiple medical conditions
  • Have a complex medical history
  • Need assistance to become more self-reliant in managing their health care


This information is issued on behalf of Highmark Wholecare, coverage by Gateway Health Plan, which is an independent licensee of the Blue Cross Blue Shield Association. Highmark Wholecare serves a Medicaid plan to Blue Shield members in 13 counties in central Pennsylvania, as well as, to Blue Cross Blue Shield members in 27 counties in western Pennsylvania. Highmark Wholecare serves Medicare Dual Special Needs plans (D-SNP) to Blue Shield members in 14 counties in northeastern Pennsylvania, 12 counties in central Pennsylvania, 5 counties in southeastern Pennsylvania, and to Blue Cross Blue Shield members in 27 counties in western Pennsylvania.

Health benefits or health benefit administration may be provided by or through Highmark Wholecare, coverage by Gateway Health Plan, an independent licensee of the Blue Cross Blue Shield Association (“Highmark Wholecare”). Highmark Wholecare offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal.



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