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Care Management Entities

Care Management Entities. A Service Delivery Strategy for Colorado’s System of Care Draft July 11, 2012. What is a Care Management Entity?.

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Care Management Entities

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  1. Care Management Entities A Service Delivery Strategy for Colorado’s System of Care Draft July 11, 2012 Draft July 11, 2012

  2. What is a Care Management Entity? An organizational entity that serves as a centralized accountable hub to coordinate all care for youth with complex behavioral health challenges who are involved in multiple systems and their families(Center for Health Care Strategies, Inc., 2011). Draft July 11, 2012

  3. Goals • Improve clinical and functional outcomes • Enhance system efficiencies and control costs • Foster resiliency in families and youth • By: Draft July 11, 2012

  4. Population of Focus Draft July 11, 2012

  5. Functions • High quality wraparound • Screening, assessment and clinical oversight • Intensive care coordination • Information management, including real time date • Access to family and youth supports/advocacy • Access to crisis supports • Development of provider networks including natural and culturally relevant supports Draft July 11, 2012

  6. Functions (cont’d) • Utilization management and quality improvement • Outcomes management • Training for CME staff, providers, families and referring entities • Case monitoring and review Draft July 11, 2012

  7. Family and Youth Support • All families and youth should have access to peer support. • Each of the existing care management entity models, e.g., NJ, MD, Dawn Project, Wraparound Milwaukee, includes a partnership with a family/youth support organization. Draft July 11, 2012

  8. Types of Organizations That Can Serve as CMEs Draft July 11, 2012

  9. Financing Streams • Medicaid Options • Child Welfare- Title IV-E Waiver • Juvenile Justice • Mental Health and Substance Abuse • Education • Others Draft July 11, 2012

  10. Outcomes • Improved Clinical and Functional Outcomes • Significant Cost Savings • Promotes Health Homes Concepts • Supports Comprehensive System of Care Approach • Examples from states/communities: • Reduction in placement disruption in child welfare from 65% to 30% (Milwaukee) • 60% reduction in recidivism rates for delinquent youth/1 yr. (Milwaukee) • School attendance for child welfare-involved children improved from 71% days attended to 86% attended (Milwaukee) • Reduction in psychiatric inpatient days from 5000 days per year to less than 200 (Milwaukee) • 30% net reductions in Medicaid spending-decreases in PRTF and inpatient with increases in TCM and home and community services (Maine) Draft July 11, 2012

  11. Colorado Population Of Focus Children and adolescents with a serious emotional disturbance who are in, or at imminent risk of, placement in institutional care. Institutional care is defined as a living situation for 10 or more children including, but not limited to, residential treatment facilities. Draft July 11, 2012

  12. Trauma-Informed Integrated Service and Support Delivery Model System of Care Values and Principles Behavioral Health Transformation Council State Oversight Body (Committee of BHTC) Local Guiding Group Family and Youth Support Organization (Peer Support) Care Management Entity DRAFT Draft July 11, 2012

  13. Feedback Common Standards with local delivery-different variations on state. regional, community Use existing regions i.e. BHO, RCCOs Consumer Voice at all phases Legislation informed by demonstration site Draft July 11, 2012

  14. Resources • Analysis of various care management models – Tracy Kraft-Tharp • PowerPoint by Bruce Kamradt, Wraparound Milwaukee • Care Management Entities: A Primer - Sheila Pires • Model Draft July 11, 2012

  15. Acknowledgements • Sheila Pires, Partner, Human Service Collaborative • Bruce Kamradt, Director, Wraparound Milwaukee • Tracy Kraft-Tharp, Co-Project Manager Draft July 11, 2012

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