Because care management and coordination often defy traditional return on investment formulas, come budget time, AltaMed Health Services Corporation had to take a hard look at contributions of its multidisciplinary care team to the organizational bottom line.
Shameka Coles, AltaMed’s associate vice president of medical management, outlines seven key metrics presented to AltaMed’s CFO tying the coordinated care team to Altamed’s financial goals—data that ultimately secured funding for phase four of the coordinated care management initiative.
Relationships with community organizations that support mental health as well as recovery from addiction are essential to care coordination of Medicare-Medicaid beneficiaries, notes Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation (HCSC). These collaborations enable HCSC to address the needs of duals as “a whole sick person, and not just as a diagnosis,” she explains, noting that duals often suffer from depression along with some physical disability. HCSC also has its own integrated team with behavioral health expertise.
The philosophy that healthcare is local and therefore, care needs to be local and community-based forms the core of WellCare’s efforts to connect its dually eligible population to health services, explains Pamme Taylor, WellCare’s vice president of advocacy and community-based programs. The Tampa-based healthcare company takes a culturally competent approach to assessing duals’ unique personal circumstances, ensuring their “soft landing” into WellCare’s care coordination system.
Care managers at the heart of WellCare’s multidisciplinary team, conducting a comprehensive needs assessment with each Medicare-Medicaid beneficiary and driving the resulting care plan, ensuring duals’ complex care needs are met at the most appropriate time and level.
SCAN Health Plan’s Interdisciplinary Care Team for dual eligibles is a diverse multiprofessional group encompassing many geriatric specialists, explains Dr. Timothy Schwab, chief medical officer of SCAN Health Plan. Dr. Schwab describes some of the challenges of risk stratification in a dual eligible population, and details case management support for the percentage of dual eligibles that require support for disabilities.