Health plan, vendor work on problem solving
Medicaid population offers unique challenges
Case managers who deal with Medicaid populations face a number of challenges they don’t encounter in a commercial population.
And Medicaid patients with chronic diseases are among the toughest in health care to manage.
"Our members have chaotic lives. They can’t get in for a physician visit or get their kids in for a physician visit because of some other event occurring in their lives. It makes them a complex population to manage," says Mary Deering, RN, MPH, manager of disease management for UCare Minnesota, a Minneapolis-based HMO.
That’s why managing the Medicaid population is a collaborative effort between UCare Minnesota’s in-house case managers and Matria Healthcare, the vendor that manages the UCare Asthma Action disease management program.
There is a constant turnover in the UCare Medicaid population as members lose eligibility when they get a job or move.
"Getting in touch with the people is the key problem in a disease management program for this population," Deering says.
For instance, the phone numbers are missing or not in service for about 40% of the UCare members.
Keeping track of Medicaid patients can be a logistical nightmare.
Some Medicaid patients don’t have permanent homes. Many of those who do can’t afford a telephone or they move frequently.
UCare has developed in-house systems to make sure the telephone numbers and other data on the members is accurate. The customer service departments and the clinics that treat UCare clients help track down people with incorrect phone numbers and help get them reconnected with the HMO.
The diversity of UCare’s Medicaid population presents another challenge to case managers.
"Our Medicaid population includes a wide range of people who have difficulty navigating the health care system. We have a lot of members who are limited in their proficiency in the English language and who are totally unfamiliar with the American health care system," Deering adds.
The Asthma Action program is administered by Matria and staffed by nurses who specialized in respiratory care at National Jewish Medical and Research Center in Denver. "One of the reasons we chose Matria and National Jewish is that they have the expertise in working with non-native English speakers," Deering adds.
The program uses educational material written on an elementary school level with a pictures and simple ideas.
When the case managers at National Jewish call patients and pick up complex psychosocial situations or other disease conditions that may be interfering with treatment, they involve UCare’s case managers to help manage the care.
"We encourage two-way communication between our on-staff case managers and those at National Jewish. Their expertise is in respiratory care management," says Craig Christianson, MD, UCare’s medical director for state public programs.
For instance, one participant in the asthma management program had significant psycho-social problems. National Jewish case managers got the UCare case managers involved to get her connected to mental health services.
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