Since healthcare is local, it's vital that health systems engage local providers, enlisting both clinical and administrative champions, advises Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation. Ms. Faulhaber offers a variety of guidelines for engagement of community partners in care coordination for Medicare and Medicaid beneficiaries.
Our community care coordination partners may employ different models of care coordination. First, some may have care systems, larger accountable care organization (ACO)-type organizations; many take full financial risk, including risk on home- and community-based services. There are also waivers.
Second, some of these large care systems also have nurse practitioner (NP) models that provide mainly facility-based care. Those can be extremely successful with outcomes for the numbers, as well as from a cost perspective. Third, we also work with care management organizations and providers. Another example would be the Triple A’s—Adult Areas Agencies on Aging—and other behavioral health organizations. In our experience, these organizations will take on some financial risk, but really for those care coordination services.
Fourth, there are many different financial models you can use with both groups, particularly for the care management organization providers. For example, looking at a risk on care coordination, gain sharing—potentially in a new program—helping to pay for some startup infrastructure cost, providing loans with some paybacks. There are many different opportunities to make it financially viable for those important community partners to work with health plans in order to provide community-based, social model services to the member to meet all of their needs.
Finally, when working with community partners, it is critical to have both a clinical and administrative champion for the program. Clinically, it helps to have a physician nurse who can talk with their peers in the organization to help them understand the program. Clinicians want to provide care in a very uniform way, but if there is an opportunity to provide additional benefits in lieu of services for members, it helps to have that clinician champion to be able to share that.
Administratively, it is also important to manage the enrollment and care coordination paperwork. The plans are putting significant faith in these organizations to meet their contractual obligations, so having someone to follow up for those types of things is critical. It is also important to provide reporting and feedback on the results for these groups. We have done quarterly meetings in the past, which I found to be very helpful.
It is also helpful to provide benchmarking data. We look at how one organization serving the same population in a similar environment shapes up in comparison to another. This has improved results overall; it makes those organizations leading the pack feel good, and provides those trying to catch up with some role models to look at.
Excerpted from: Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population