CareManager: Care Coordination Software Solutions for the Health and Human Services Industry

With increasing pressure to coordinate care across the full spectrum of providers and better treat individual populations, health homes, accountable care organizations, dual eligibles, and care coordination agencies are emerging throughout the United States. These organizations have one goal: Connect provider organizations and share an individual’s data with the purpose of creating better outcomes and reducing costs.

CareManager, our care coordination software solution:

  • Aggregates clinical data to provide a broad picture at the population level
  • Facilitates care coordination across providers
  • Tracks clinical quality measures and outcomes
  • Manage authorizations and claims across care providers

We believe in your mission…it’s ours too. Sweeping changes in the healthcare community are driving person-centered care. And, we understand the importance of organizations being connected and sharing information. Our easy-to-use CareManager solution is focused on the way you work. In fact, it was designed by working directly with care coordinators performing outreach and care management activities. And, it’s currently being used by HIEs and some of the largest health homes in the United States. In fact, it’s being used in these different types of settings:

Facilitated Referral

Facilitated Referral - Care Coordination Software for HIEs and Health Homes

In this approach, the managing organization does not provide care. The Facilitated Referral Health Home partners with care coordination agencies. This partnership ensures the individual members of the health home receive the right care at the right time in the most appropriate environment.

Where It’s Happening With CareManager:

Washington State asked five health plans to drive toward becoming health homes. These health homes would ensure each Medicaid and dual eligible beneficiary who is considered high risk be assigned to a lead agency. The lead agency, and its network of care coordination organizations, are responsible for managing and coordinating the complete care of these high-risk individuals.

These individuals may have multiple chronic conditions including Asthma, COPD, HIV, Schizophrenia, Depression, Diabetes or a BMI over 25. Ultimately, if an individual has an annual cost to Medicaid greater than 50% above average, they are considered health home eligible. CareManager is being used by a care manager that manages the health home population in four of the seven regions in Washington State. They work with local providers in each of the regions and believes direct face-to-face care is the best way to achieve healthier results.

Co-Located Health Home

Co-Located Health Home - Care Coordination Software for HIEs and Health Homes

Exists in provider organizations focused on ensuring members receive primary or physical healthcare services. In this example Primary Care practitioners are embedded in a behavioral health setting. This approach is generally taken by health and human service providers who are expanding the care they provide to include primary care services by utilizing physicians as consultants.

Where It’s Happening With CareManager, our Primary Care Module & CareRecord™:

Henderson Behavioral Health in Fort Lauderdale, Florida, provides a full continuum of care in six outpatient centers with over 25,000 adults, children and families in Broward & Palm Beach Counties served annually. Their four outpatient primary care locations serve the same client base encompassing the entire workflow – providers treat the entire individual in one EHR through the integration of primary care services into behavioral health/substance use. 29% of adults with medical conditions also have mental health conditions.* 68% of adults with mental health conditions also have medical conditions. The ability to treat the body and the mind in one workflow is instrumental in giving patients the treatment they need.

*Robert Wood Johnson, 2011 – Mental Health Comorbidity

In-House

In-House - Care Coordination Software for HIEs and Health

Starts when a single health and human services provider establishes their own primary care clinic. This model has primary care practitioners fully employed within the organization.

Where It’s Happening With CareManager

Youth Emergency Services and Shelter (YESS) in Des Moines, Iowa, is coordinating and managing the care, as well as providing needed primary care services to a population of more than 1,000 children. To accomplish this task, YESS partners with Magellan. Together they make up the health home for a population who desperately needs their focus. Their care provision and care management is supported by our CareRecord™, CarePathways™, myHealthPointe™, Revenue Cycle Management and CareConnect™.

Real World Model

Experience dictates your health home will be a hybrid of the above models…embedded primary care, managing individuals who are treated by other providers and working to manage the information when it is collected from multiple sources.

Ultimately, this hybrid approach is the goal, gaining full visibility into the care that an individual receives wherever they receive that care, whether it is within your four walls or in other facilities. A health home’s lifeblood will be its ability to follow and support these individuals as they navigate the healthcare ecosystem. And, CareManager is the foundation for this, or any of the models your organization falls under. Most importantly, CareManager is not dependent on any electronic health record. It integrates into your existing clinical systems to support your population management strategy.

For more information on our care coordination solutions, contact us.

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