Care management aims to ensure that every person served by a public welfare system has a plan of care directed toward appropriate outcomes. To avoid duplicate efforts, public welfare agencies need clear boundaries for each management office. In this structured context, the role of the care management function may involve:
- Determining eligibility
- Conducting non-clinical assessments
- Defining care objectives
- Authorizing, planning, monitoring, and reviewing services
- Creating care linkages
- Coordinating benefit packages
- Planning for discharge
Rather than distinguishing long-term case management from event-based care management, ACA upholds a holistic approach to care planning and delivery that integrates case and care management and helps care recipients as they interact with the system. While conventionally considered an administrative effort and not a clinical intervention, case management is essential for the lasting success of care delivery, since many populations have difficulties navigating through the system.
Needs in Care Management
Holistic care planning and delivery requires a structured environment in which public welfare agencies continuously coordinate case-level, episode-level, and encounter-level events. Because of volatile consumer populations, these agencies must also continuously monitor consumers’ eligibility for care. Finally, if a person is determined to be ineligible, multiple regulatory and funding authorities require that agencies attempt to find another solution.
To coordinate care across funding streams and program boundaries, public agencies need to recognize traditional elements of care management, such as pre-authorization of services and utilization review, as components of a case management continuum. Within this continuum, resource utilization considerations will not affect care planning, and authorizations will ensure that consumers receive the most appropriate, cost-effective care, rather than mediocre care that is less expensive or more accessible.
ACA’s Care Management Model
ACA’s model of public welfare care management combines long-term structured assistance with short-term care for individual events. Integrated case and care management is essential, and technological and administrative advances have made this possible.
Through our consulting and information technology services, we assist our public welfare industry customers in enhancing their care management efforts. Our involvement in improving care management functions is extensive:
- Our MASTRR™ Solutions products assist human services agencies in all aspects of their case and care management activities.
- For a multi-county collaborative, we integrated case and care management efforts of behavioral health agencies across county boundaries and funding streams. To produce better care with improved access and greater consumer choice, our model set uniform standards for all members of the collaborative and developed a twenty-four hour service center for consumers.
- Our software separately monitors case and episode responsibilities, the organizational structure of an agency, and service-related competencies of agency staff. This allows case and care managers to make informed decisions based on their review of service planning and delivery patterns by case, episode, agency unit, service category, individual service, and other data.
- Through our modeling and regulatory compliance and reporting services, we help human services agencies assess the efficiency of their care and case management efforts. These services allow our customers to maintain environment-specific care definition schemes while achieving compliance through the extensive cross-referencing capabilities we offer.
- We have analyzed data about dually diagnosed individuals to help program managers formulate better approaches to treatment.
- We analyze consumer participation in service delivery to unveil cultural barriers, provider network deficiencies, problems with transportation, and other issues. This, in turn, helps agencies select care alternatives, or use step-down services, diversion programs, or other treatment options.
Innovative Solutions in Care Management
To pursue long-term recovery for clients, case management must cross program boundaries and limitations imposed by regulatory and funding authorities. ACA can help your organization work toward this goal by:
- Establishing a “fair deal” environment, where a public system and each of its recipients accept mutual responsibilities for care planning, delivery, and participation
- Balancing encounter-level, episode-level, and case-level objectives and decisions
- Separating care management and resource management decisions at the encounter level, while integrating them at the program and system levels
- Balancing the interests of individuals and their families
- Avoiding duplicate care management efforts
- Providing ongoing assistance to public welfare recipients in navigating the system
- Satisfying care access, consumer choice, and care quality standards
The rigorous information needs of the public welfare environment call for a unique model for managing and interpreting information to coordinate care. By integrating case and care management functions, we have developed a model that helps human services agencies enhance the administration of their services.
This model is applicable across funding streams, program offices, and administrative boundaries, emphasizing the concept of a single point of responsibility within human services programs. A care management team approach to treatment, especially for high-risk populations, can integrate care across silos.
MASTRR™ Solutions products support coordinated care management by maintaining information about each person and their care givers. Our application's security protects confidential information while allowing the case management team to retrieve and maintain information and to analyze the person's treatment history and interaction with the system.