CARE MANAGEMENT LESSONS LEARNED

Transcription

1 CARE MANAGEMENT LESSONS LEARNED

2 SCM VS. CARE MANAGEMENT 50 slots 2.5 Staff SCM 2 Face to Face contacts per month required Majority of Services are provided in the field Focus on providing linkages, advocacy and support Service Dollars Medicaid Billable On-Call Services Seldom Utilized HH Care Management 50 legacy slots (32 OMH and 18 DOH) and Expansion Slots (TBD) 3 FTE at this time Various types of contacts permitted base upon need Services are provided in the field and via phone Care Manager s focus is to ensure critical living, behavioral and physical health needs are provided Service dollars for legacy slots only? Medicaid Billable Upstream Payable On-Call Services Utilized to Report Need for Emergency Medical Services

3 SCM VS. CARE MANAGEMENT (CONT.) SCM SPOA was the source of all referrals Care Management Assignments come from Care Central and SPOA

4 CLIENT PROFILE SCM SMI 100% Substance Abuse 60% Physical Health % Medicaid 80-90% Care Management SMI 98% Substance Abuse 70% Physical Health 100% Medicaid100%* *requirement to be in Health Home some legacy are non- Medicaid

5 PHYSICAL HEALTH ISSUES Diabetes Hepatitis High Blood Pressure Cancer Obesity Hypothyroidism Asthma COPD GERD High Cholesterol Chronic Pain Etc.

6 CARE (PROVIDER) INVOLVEMENTS SCM Ellis Mental Health Services DSS Services RSS Services Mohawk Services Conifer Park New Choices Limited Health Care Schenectady MHA Care Management All of the SCM plus: Care Central Navigator Primary Care Specialist Care Home Health Services Hometown Health Schenectady Free Clinic Physical Therapy Urgent Care Inpatient Various Labs Etc.

7 SCHENECTADY CARE MANAGEMENT CAPACITY? OMH Legacy (32)* DOH Legacy (18)* DOH Expansion (98)** *Filled by referrals from SPOA to ensure slots are filled by individuals with SMI **Staff will be added as downstream referrals indicate

8 MEDICAID BILLING RATE CODES SCM $ per month Care Management $ per month for 32 OMH legacy slots $ per month for 18 DOH legacy slots $ per month for Health Home expansion slots $ per month for all engagement services (OMH/DOH)

9 PROVISION AND DOCUMENTATION OF SERVICES SCM Service Plan via our EMR Progress notes via EMR Plan focused on linkages to create greater independence. Minimum 2 service contacts per month Services across all life domains (housing, education, family/parenting, employment, behavioral and physical health) Care Management Care Plan and documentation in two EMR s. Need to Complete Notes in the field due to volume Primary plan is focused on reducing use of emergency and hospital services Minimum 1 service contact per month of any type Services promote over-all health and well being

10 CASE MANAGEMENT VS. CARE MANAGEMENT Case Management- Jan 2011 For 50 Consumers/2.5 FTE Total contacts: contacts per client 57 contacts per staff Care Management Jan 2013 For 146 Consumers/3 FTE Total contacts: contacts per client 118 contacts per staff

11 CHALLENGES Educating the consumers, providers and system in general on Health Homes Collaboration, arbitration and facilitation amongst providers Transportation to urgent care facilities and various appointments Housing The need for immediate (same day)appointment slots at clinics and doctors offices (This is improving each month) Documentation in two electronic case records and accessing both in the field

12 OUR GREATEST CHALLENGE: OUTREACH AND ENGAGEMENT Referrals from Care Central (via MCO s and DOH) Limited to 90 days (Care Central utilizes the first 30 days to verify contact information and attempt engagement) Initial data received is not always accurate, phone number, address and current Medicaid eligibility Individuals contacted have little if any knowledge of HH services Current engagement rate about 40%

13 FUTURE CONCERNS How to calculate effective staff to client ratios in an fiscally responsible manner Billing Care Central and not Medicaid Achieving and measuring outcomes Data Management, linkages to Care Team Connect, RHIOS etc. Improving outreach and engagement techniques Housing Resources