Enhanced Care Management Overview - Community Health Group

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hi my name is erica robles today i will

be providing you an overview of

community health groups new benefit

enhanced care management also known as

ecm i will be reviewing the population

of focus covered in this program as well

as the core services offered

ecm is a whole person approach to care

that addresses the needs of members with

the most complex medical and social

conditions through coordination of

services and comprehensive care

management

this program will cover adults that are

experiencing homelessness high utilizers

adults with smi or sud

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transitioning from incarceration

individuals at risk for

institutionalization who are eligible

for long-term care services and or

nursing facility residents transitioning

to the community

and

children

up to age 21 that are experiencing

homelessness

high utilizers

children with sed or chr

enrolled in ccs or ccs whole child model

with needs beyond the ccs qualifying

condition

currently or previously involved in

child welfare

and or children transitioning from

incarceration

to improve the health and well-being of

these populations ecm is comprised of

seven core services

these services are outreach and

engagement

comprehensive assessment and care

management

enhanced care coordination

health promotion

comprehensive transitional care

member and family supports and

coordination of and referral to

community and social support services

now let's take a closer look at these

core services

community health group will be

responsible for identifying members who

qualify for ecm and assigning them to an

ecm provider

members will be tiered into three risk

levels

high moderate and low ecm providers are

responsible for reaching out to and

engaging assigned members

the ideal and preferred method for

outreach is in-person contact if that is

not possible providers may also reach

out to member by mail email text

telephone or telehealth

to comply with the outreach requirement

outreach attempts must be spread over a

two-month period with three attempts per

month for a total of six attempts

all attempts must be documented and made

on a separate date and time

it is important to note that member

outreach will count as successful once

the ecm provider has documented the

member has opted in or declined

ecm services or they have exhausted all

six attempts whichever occurs sooner ecm

providers will be paid only for

successful outreach

once ecm providers have enrolled the

member into the ecm program they will

commence the comprehensive assessment

and care plan process

activities for comprehensive assessment

and care management plan include

evaluating the members clinical and

non-clinical needs to identify gaps in

care

developing a comprehensive plan that

includes the members strengths risks

needs and goals

incorporating strategies to address

healthcare and social needs

reassessment every six months unless a

member's health should dictate sooner

and ensuring that the care plan is under

appropriate clinical oversight

when developing care plans care plans

will have a problem

a goal to overcome the problem

interventions to meet the goal

and any applicable outcomes

once a care plan has been created with

the member by the lead care manager it

will be used as a guide for enhanced

coordination of care

enhanced coordination of care includes

all of the services necessary to

implement the care plan

ecm providers are responsible for

using the care plan to organize care

activities and involve all individuals

needed to execute those activities

providing support to members to engage

them in their treatment such as

medication review scheduling

appointments and or coordinating

transportation

following up with a member to review

care plan goals and needs and ensuring

regular contact with a member and or

authorized representative

health promotion is another core service

ecm providers are responsible for

encouraging and supporting members to

make healthy lifestyle choices

ecm providers shall support members by

working with them to identify and build

on family and or support networks

linking members to self-help recovery

resources

and engaging members to participate in

and manage their care

for example you may have a member with

uncontrolled diabetes and their care

plan goal is to reduce their a1c by

three percent in the next four months an

intervention could be to meet one-on-one

with a health educator or attend a group

class on diabetes to improve their

knowledge on their chronic condition and

self-management skills

comprehensive transitional care

includes services that are intended to

support ecm members who are discharged

from facility settings to ease their

transition back into the community

this can help avoid unnecessary

readmissions

ecm providers are responsible for

developing an updated transition plan

coordinating any support services to

facilitate the transition

tracking member admission and discharges

and communicating to appropriate care

team members

coordinating medication review and

providing adherent support and referrals

to appropriate services

member and family supports are

activities that ensure that the member

and their authorized representative

adhere to the members treatment

management

member and family supports includes

documenting the members authorized

representative

ensuring all required authorizations are

in place

educating the member on their care plan

and resources to adhere to it

ensuring that the member's ecm lead care

manager serves as a point of contact and

providing the member with a copy of

their care plan and information on how

to request updates

coordination of and referral to

community and social support services

includes determining the appropriate

services that meet the members needs to

address any present or emerging social

factors this includes

identifying needs to offer community

support services when appropriate and

coordinating referrals to other

community resources

we have now reviewed all seven core

services

thank you for being an ecm provider and

taking care of our members with the most

complex needs remember it's the

community that counts and we'll see you

next time

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