policy
Understanding Medicaid Managed Care – Care Management
CARE MANAGEMENT: How Safety Net Health Plans Improve Care and Quality of Life
Care Management | Housing | Jobs | Community Partnerships
One of the most fundamental ways in which Safety Net Health Plans — and Medicaid managed care plans of all stripes — improve the quality of life through their members is through care management, an essential function of all health plans.
Care management can be broadly defined as the effort to coordinate care and benefits for health plan members in such a way to assure that their care is continuous, appropriate and of high quality.
Care managers working for ACAP-member Safety Net Health Plans help health plan members access the care and services they need and connect members to available resources in the community.
While care management can take on a wide range of forms, it can generally be characterized as a health plan’s devotion of resources and staff time to assuring that its members get the care they need. This may include reminding members that they are due for a checkup or immunization, or connecting a member to a provider who sees patients on weekends.
Here’s a real-life example of how care coordination can improve the lives of Safety Net Health Plan members: Sheila Putnam of CareSource, an ACAP-member plan based in Ohio, describes how the plan worked to deliver specialized services–as well as a single point of contact–to help a member with two children, one of whom needed a cochlear implant and another who lived with asthma.
Care management for people eligible for both Medicare and Medicaid
Care management is a hallmark of Safety Net Health Plans who serve people who are eligible for both Medicare and Medicaid, or “dual eligibles.” Such members tend to be among the poorest, most frail, and medically needy. There are only about 9 million Americans who qualify for both programs, but they account for nearly $300 billion in health care costs per year. As a result, they stand to benefit the most for the care management services offered by Safety Net Health Plans.
All plans serving dual eligibles are required to develop a Model of Care which describes the unique approach the plan uses to assess and meet the care needs of their enrollees. Further, plans employ care managers to develop individual care plans for each of their members.
Sometimes care management can lead to simple solutions that have outsized effects: one Safety Net Health Plan had a dual-eligible member who was cared for by his wife, who was 90 years old; she had trouble reading the instructions printed on the sides of the pill bottle and accidentally administered an overdose. A care manager intervened and simply asked the pharmacy to print the labels in big type to avert future problems.
Other plans have taken more intensive approaches to care management. Commonwealth Care Alliance of Massachusetts employs nurse practitioner care managers to pay house calls to many of its members, not only helping them adhere to their medications but also taking vitals. It makes a real difference in the lives of their members; see how it makes a difference in the video below.
Partnerships in the Community to Promote Care
A defining characteristic of Safety Net Health Plans is their community roots. Many ACAP-member plans form partnerships in the community in an effort to improve health using care management techniques. One example of this is the Asthma CarePartners program, a collaboration between Sinai Urban Health Institute and Family Health Network of Chicago. This partnership employs Community Health Workers employed by Family Health Network in an effort to educate asthma-affected individuals about the disease, its triggers, and proper management, in their home and over the phone.
It’s designed to help adults, children and their caregivers improve asthma control so that everyone can stay out of the emergency room and lead active, healthier, happier lives. The difference it’s making in the lives of Chicagoans can be seen below.