Provider Educational
Seminar
Care Management: Part I
4/10/2015
4/10/2015
Clinical Initiatives: Care Management
Divisions within Care Management:
• Case Management
• Utilization Management
• Special Needs
• Social Work
• Health Promotion and Wellness
• Outreach
• Evaluations and Outcomes
Presented by: Johns Hopkins HealthCare
4/10/2015
Care Management
JHHC’s unique care management approach:
• Targets entire population
• Focuses on continuum of care
• Tiered management approach with three levels of intervention
• Targeted diagnoses: diabetes, asthma, cardiovascular disease, COPD
Presented by: Johns Hopkins HealthCare
4/10/2015
Care Management
Level 1: High Intensity
Level 1
Complex
Case
Management
Level 2
Monitored Case
Management
•Delivered by Complex Case Managers
•Care coordination services
•Individualized case management plan
•TeleWatch RN telemonitoring
Level 2: Moderate Intensity
•Condition-specific interventions
•Focus on improving health status
•TeleWatch telemonitoring
Level 3
Lifestyle Management
Patient-Centered Interventions
DATA DRIVEN
Presented by: Johns Hopkins HealthCare
4/10/2015
Level 3: Low Intensity
•Awareness
•Prevention
•Web-based interventions
•Health coaching & education
Care Management
Specialty care management programs target members with:
• High risk pregnancy (Partners with Mom)
• HIV/AIDS
• End State Renal Disease
• Rehabilitation needs
• Terminal illness or are at the end of life (Omega Life)
• Children with Special Needs
Presented by: Johns Hopkins HealthCare
4/10/2015
Care Management
Care Management Strategies:
•
Focus on members with chronic, complex or catastrophic injuries
or illness, or those requiring significant self-care
•
Collaborate with physicians and support service providers to focus
on the patient
•
Routine reporting/communication with patient, physician, health
plan, and support service providers
•
Promote patient/member satisfaction
•
Patient self management education
Presented by: Johns Hopkins HealthCare
4/10/2015
Care Management:
Case Management
Process:
•
Identification of at-risk members
•
Comprehensive assessment and intervention using evidence-based guidelines
•
Development of treatment plan
•
Intense outpatient follow-up
•
Monitoring to ensure adherence to treatment/determine willingness to change
•
Evaluation and outcomes
Presented by: Johns Hopkins HealthCare
4/10/2015
Care Management:
Case Management – High Intensity
Overview:
• Work one-on-one with members with complex chronic conditions
• Provide comprehensive assessments
• Periodic visits, phone calls, e-mails
• Individualized care plans with agreed-upon goals
• Use of special tools like the TeleWatch Monitoring System
• Work collaboratively with all involved parties: member, health care
providers, behavioral health, support services, home care, vendors
Presented by: Johns Hopkins HealthCare
4/10/2015