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Care Management in Public Welfare

Care management encompasses a set of activities to assure that every person served by a public system has a plan of care designed to assure appropriate outcomes. Care management, as defined by ACA, may include such functions as determination and periodic re-determination of eligibility; non-clinical assessment and re-assessment; determination of care objectives; service planning, monitoring, and review; service authorization; care linkages; arrangement and coordination of benefit packages; and discharge planning. A particular portfolio of projects encompassed under the auspice of care management is formed under the influence of numerous factors, for example:

• Served populations;
• Administrative level (e.g., federal, state, local);
• Organizational model;
• Regulatory framework;
• Program (system) profile and benefit packages;
• Stakeholder participation;
• Level of program (system) integration; and
• Resource management arrangements.

The growing diversity of public welfare programs, complexity of their administration, and difficulties with their adequate funding place significant demands on all management areas of public systems of care. Toward this end, one of the major needs of a public welfare agency is to establish and maintain clearly defined boundaries for each separate management office with meaningful accountability and avoiding duplication of efforts. In this context, the principal role of the care management function is to assure that every person served by a public system has a plan of care designed to achieve appropriate outcomes and that timely and quality services are rendered in accordance with the plan.

ACA always attempts to approach care management issues in their relationship with other management areas in public welfare.

In ACA definition, care management functions encompass case management activities, despite the fact that such approach may not be consistent with traditional views in many human services areas that associate case management with longer-term objectives and care management with events (occurrences) and/or their related groups. Our integration of case and care management is focused on a holistic approach to care planning and delivery when a public system assumes certain responsibility to assist care recipients in their interaction with the system. While conventionally considered an administrative effort and not a clinical intervention, the need for case management is particularly essential for the lasting success of care delivery, especially when addressing special populations that, for one reason or another, experience difficulties navigating through the system.

The ACA contribution to innovative solutions responsive to the needs of public welfare industry is most visible in such areas as consulting and modeling, monitoring of managed care programs, regulatory compliance and reporting, and use of MASTRR™ Solutions product family. In its professional engagements, ACA always attempts to approach care management issues in their relationship with other management areas in public welfare.

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