CareSource’s mission of “making a difference in the lives of underserved people by improving their health care” drives its business strategy. Last year, the focus on its mission helped CareSource pave the way for a new model of care in Ohio with the High Risk Case Management (HRCM) program. The HRCM program is structured so that a team of health-care professionals works with individual members to develop an individual care plan to help them live better with their medical conditions. The goals of the program are to enhance treatment adherence, improve member outcomes, promote health behavior change, decrease emergency room visits, and decrease inpatient admissions.
The five-month transition to HRCM required the hiring and training of 350 employees, shifting from office-based employees to mobile-based employees, creating a new job function called a Navigator, and moving from a single point of member contact to a team of professionals charged with improving member health care.
Key training components of the program include:
- Creation of a two-day Navigator training program for the new Navigator role. Instead of sending each Navigator to a vendor’s five-day training, CareSource University’s (CSU) in-house program saves $1,360 per participant and is tailored to better reflect members’ specific needs.
- Creation of a new app for the iPhone, which interacts directly with the primary HRCM system. The app allows the user to view, complete, and document member interactions. CSU converted all training materials into the help file of the app so each of the 350 mobile workers has instant access to the training.
- Traditional instructor-led, clinical-focused “Brown Bag Lunch” sessions converted to Webcasts. These were made available to the mobile staff as on-demand training. In the six weeks after launch, 117 employees accessed the courses, saving $6,000 in travel expenses.
CSU also trained all new hires on care management skills focusing on the importance of the member’s involvement in achieving positive health outcomes. Given the community-based nature of these new positions CSU offered two new courses: one through a partnership with local police on personal safety, and the other on “How to Speak Dog,” which focused on dog behavior and body language to reduce the risk of dog bites.
Results
The Ohio Office of Medical Assistance conducted a survey to evaluate the effectiveness of HRCM. The survey showed that CareSource scored significantly higher than the program average in the following key impact areas:
- Member’s knowledge of which services are available: mean of .92
- Member’s participation in development of a care plan: mean of .97
- Member’s involvement in deciding goals of the care plan: mean of .99
- Member was helped by the care management program: mean of .86
- A 41 percent reduction in inpatient hospital stays
- A 30 percent reduction in hospital readmissions
Overall, the State of Ohio states in the survey that “CareSource’s results were significantly higher than the program rates more frequently than any other managed care plan.”
