Where should you look for community partners?
Where should you look for community partners?
Experts say look no further than your Rolodex
There's no special formula Medicare-risk plans should use to find partners in the community. If you're looking for qualified professionals to help deliver appropriate care for Alzheimer's patients, look no further than your network of community resources, say experts recently awarded grants to fund managed care demonstration projects for dementia patients by the Alz heimer's Association in Chicago. (For more details on managed care for demen tia patients, see story, below right.)
For its demonstration project, Legacy Health System in Portland turned to the Oregon Trail Chapter of the Alzheimer's Association to provide care management services for its members with dementia. "Legacy gave this chapter its first home. We have our offices in an old house that sits on the Legacy campus," says Julie Johnson, MSW, program director for the Oregon Trail Chapter. "We have a long history of working together, and doing this project together was a natural match."
Similarly, Anthem Blue Cross and Blue Shield of Connecticut in North Haven and Connecticut Community Care in Bristol also have a shared history. "We have contracted with CCCI [Connec ticut Community Care] to do case management for a long time," notes Julie M. Gelgauda, MS, LCSW, health and wellness advisor for Anthem Blue Cross and Blue Shield. "We have always depended on them to give us their best advice. That's why this partnership has worked so well. There were never any turf issues."
However, even when partnerships are natural extensions of a long-standing relationship, starting a project can take time, Johnson cautions. "When we started this relationship, we didn't appreciate the time it would take to work out all the policies and procedures and get the project under way," she says. "I thought the process would be easy: Legacy would identify members at risk and refer them to us for case management. I didn't appreciate the problems there would be identifying members. I also didn't realize how each step had to be refined. These things don't come out fully formed."
Adding to the delays in launching the project, the state of Oregon and researchers at the Uni versity of Kansas in Lawrence also are involved in the Legacy/Oregon Trail demonstration project. "There was a big kickoff meeting with all sides present," says Johnson. "After that, there was a great deal of faxing and e-mail, all to discuss what our roles were and to establish the document flow for cases we managed."
Agreeing on policies and procedures may take time, but establishing partnerships in the community is well worth the effort, and it may solve your managed care woes, says Baxter. "I think there are more opportunities available than most managed care plans realize. I see health systems and physician groups looking for people to partner with. One large capitated physician group in our area is paying a private physician to work with their homebound seniors. That was a population they were struggling to manage."
Medicare risk plans all face the same major challenge: How do plans get high-risk members into clinics for a comprehensive assessment before they have a health crisis? "Partnering with community agencies and even, in some instances, with competitors offers health plans, health systems, and physicians a unique opportunity to solve the problem everyone in managed care is struggling with," Baxter says. "Collaborating to serve frail elderly populations offers our best chance for successfully managing it."
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