Cal MediConnect: Care Management & Collaboration to Achieve - - PowerPoint PPT Presentation

Cal MediConnect: Care Management & Collaboration to Achieve Patient- Centered Care for Duals Eligible Beneficiaries Living with Mental Illness

Clayton Chau, MD, PhD, Senior Medical Director, Health Services, L.A. Care Associate Clinical Professor of Psychiatry, UCI cchau@lacare.org Yvette Willock, LCSW, MA, Program Manager, LA CountyDepartment of Mental Health, Health Agency Ywillock@dmh.lacounty.gov Lamar Smith, PsyD, Clinical Director, Behavioral Health Services, L.A. Care Lsmith2@lacare.org

Disclosure

Ms Willock, Drs. Chau and Smith have no Relevant financial relationships with commercial interests to disclose.

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 Overview of Cal MediConnect  Care coordination across agencies –

successes and challenges

 L.A. Care’s Integrated Care Management

model

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 Improve the health of the population  Enhance the patient experience

• f care (including quality,

access, and reliability)  Reduce the per capita cost of total healthcare

Overview of Cal MediConnect

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      

    

   

Care coordination across agencies – successes and challenges

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Health lth Plans Health lth Plans s Behavior vioral al Health lth Team LAC DMH Pr Provi vider ders LAC DMH Care e Coor

• rdina

ination tion Team

• Match Lists
• Client Treatment Plan Request Logs
• Client Treatment Plan Submission to Health

Plans

• Individual Care Plan (ICP) developed by Health

Plan

• Interdisciplinary Care Team (ICT) review of ICP
• Ad Hoc ICTs for on-going Care Coordination

Activities

• Full understanding of the
• Consistent Responses to CTP Requests
• Confidentiality
• Consistent Responses to requests for Care

Coordination outside of own System of Care

• Increase in CTP Submissions resulting in an

increase in the development of comprehensive CTPs

• Enhanced service delivery due to collaboration

between DMH Providers Health Plans

L.A. Care’s Integrated Care Management model

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Key Components of Case Management (Rapp & Goscha, 2004)

• 1. Case managers participate in delivering services.
• 2. Whenever possible, case management services are provided in the community and in a

person’s natural environment.

• 3. Providers use a team approach to support consumers and each other.
• 4. There is a focus on building natural community connections (e.g., landlords, employers,

ministers, neighbors, teachers, community centers, and coaches).

• 5. Case managers have access to quality supervision.
• 6. Caseload size is small enough to allow for higher frequency and quality of contact.
• 7. When possible, case management services are not time-limited for those with intensive

needs.

• 8. Consumers always have access to crisis response services.
• 9. Self-determination and consumer choice are

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Integrated Care Management Concept

To assure that each member/patient/client receives timely, effective, efficient care, at the appropriate level and with appropriate resources, and to provide psychosocial assessment and intervention for members and families with social, psychological and/or environmental needs. These needs may be related to future or current health status, diagnosis, treatment and discharge  Goals:  Member receives the right care in the right place at the right time  Improvement in the doctor-patient dyadic relationship

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Good ideas that DON’T WORK

Screening in primary care without adequate treatment / follow-up

• 20 years of negative studies
• “You can’t fatten a cow by weighing it.”

Provider education

• Knowledge is not enough
• Providers need systems and help to do the right thing

Telephone-based case management 16 negative studies with ~ 300,000 Medicare recipients

• McCall N, Cromwell J: N Engl J Med 2011;365:1704-12.
• Peikes D et al: JAMA. 2009;301(6):603-618

Member Profile

Mental Health / Substance Abuse

Neurologic Disorders 10-20% Diabetes 10-30% Heart Disease 10-30% Chronic Physical Pain 25-50% Cancer 10-20% Smoking, Obesity, Physical Inactivity 40-70% Infectious Diseases 10-40%

• Multiple providers
• No coordination
• Lack of patient focus
• Inadequate

information sharing

• No accountability
• Unaligned payment
• Accountable medical home
• Coordinated care for

patients with complex needs

• Patient-centered care
• Information exchange
• Performance measures
• Incentives/aligned

financing

Fragmented Care Integrated System

Integrated Care

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The Care Team

Team Member Role

Member

• Makes decisions about the provider, location, and services that support their recovery
• Receives education that empowers them to self-manage and remain independent

Primary Care Provider (PCP or Behavioral Health Treatment Providers)

• Maintains primary responsibility for oversight of the member’s care, including behavioral health and physical

health services

• May be a behavioral or physical health provider

Care Manager (Nurse or licensed Behavioral Health Clinician)

• Serves as the primary point of contact for the member
• Coordinates all referrals and service delivery
• Facilitates ongoing assessment and treatment planning
• Provides whole person services to meet the member’s needs

Social Worker

• Conducts ongoing reviews of the member’s service utilization, care gaps, and predictive modeling to identify

duplication of services or needs for additional support (e.g., high risk, high utilizers)

• Supports the clinical team in connecting high needs members to the community resources and services they

need Care Coordinator

• Facilitates ongoing communication between all providers and other stakeholders (e.g., jails, Child Safety,

Health Plans, Find a member)

• Follows up with the clinical team on care gap notifications, needs for preventive care

Peer Specialist

• Provide hands on face-to-face support such as attending appointments
• Important liaison
• Assist member in identifying barriers
• Transition of Care agent

Other team members (Pharmacist, Health Educator, Disease Management, Nutritionist/Dietician, MLTSS worker)

• Provide specialized knowledge and support
• Provide specialized input into care plan
• Help team members find specialists when needed

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CORE PRINCIPLES

• Specify targeted members – risk levels
• Transdisciplinary team
• Comprehensive evaluation
• PCP + Member dyad is at the center
• Motivation and activation
• Assertive and flexible
• Meeting the members where they are at
• Shared responsibilities but member driven
• Individualized services: strength based
• Self management is the end goal
• Ultimately about recovery, resiliency and

(self-) reliance

Discussion

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