From 'street case managers' that help locate and engage the homeless to tribal leaders who are liaisons to the Native American population, Health Care Service Corporation (HCSC) has assembled a dream team of community partners to support care coordination of dual eligibles.
Community mental health centers, public health agencies and community agencies round out the cadre of care coordination supports for Medicare-Medicaid beneficiaries, explained Julie Faulhaber, HCSC's vice president of enterprise Medicaid during a recent webinar on Moving Beyond the Medical Care Coordination Model for Dual Eligibles.
This safety net for dual eligibles is a hallmark of three duals care coordination models launched by HCSC in 2014two in New Mexico and one in Illinois. Results from a home-grown health risk assessment, or HRA, (conducted telephonically in almost all cases) enables HCSC to risk-stratify duals and refer them to appropriate care teams.
Other care coordination elements include interdisciplinary teams, a whole-person rather than diagnosis-driven focus and novel care and services planning that encourages out-of-the box thinkinglike the installation of a grab bar in the home of a senior somewhat unsteady on her feet.
"Putting in a grab bar might cost $150 to $200, but when you think about that in terms of having that member have a fall and having them hospitalized and the rehab cost, it just makes sense for the member's quality of life and comfort to know that there is something there to help them," noted Ms. Faulhaber.
HCSC takes great care to consider the needs of individuals with disabilities as well as those with behavioral health concerns, Ms. Faulhaber stressed, citing a 2006 study that found that individuals with severe mental health issues die 25 years earlier than those without.
While HCSC's duals care coordination interventions are new, Ms. Faulhaber believes efforts will pay off for the organization's Medicare-Medicaid members. In her more than 10 years experience with Medica Health Plans in Minnesota, where she was responsible for the dual eligible product suite, duals care coordination significantly enhanced quality and utilization metrics for that population.
Despite the efforts of HCSC and other payors to enhance duals' care coordination, significant roadblocks remain, such as transportation, a lack of integrated care, and the population's typical low scoring in risk adjustment, a common trend in groups with primary behavioral conditions, she explained.
Listen to an interview with Julie Faulhaber of Health Care Service Corporation here.
Readers, how are you rising to the challenge of duals care coordination? Are your case managers 'on the street' like HCSC's, or do you have other ways of identifying and assisting the dually eligible with their physical and behavioral health needs? Share your ideas with this community.