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Designing Healthcare Systems That Work for People With Chronic Illnesses and Disabilities
Minnesota Senior Health Options
David W. Walsh, M.H.A., Federal Program Manager, UCare Minnesota,
St. Paul, MN.
The Minnesota Senior Health Options (MSHO) program integrates
Medicaid and Medicare funds with Federal waivers and integrates acute
and long-term care services including home and community-based services
MSHO's goals are to:
- Reorganize the delivery system in order to support sound clinical
- Enhance care coordination.
- Reduce administrative complexity.
- Provide a "seamless" point of access for consumers and providers;
the program is also designed to control cost growth through incentives
to use the lowest cost intervention appropriate to the need and to change
UCare of Minnesota is one of three plans participating in MSHO.
This Managed Care Organization (MCO) decided to participate in order to develop better care coordination
for its members and to integrate across the acute and long-term care continuum.
UCare uses a primary care clinic-based system and contracts with other
systems, such as EverCare, for care coordination and physician services
for enrollees living in nursing facilities, counties for HCBS, and specialty
care providers. This network has been formed into a series of care systems,
each with unique features; UCare oversees the care system processes.
When asked about the incentive for care systems to meet MSHO's
goals, particularly to use the lowest cost intervention appropriate to
the need, Mr. Walsh replied that UCare holds quarterly meetings with each
of the care systems to discuss such issues as part of the oversight function.
Mr. Walsh described care coordination as "the linchpin of MSHO's
success." Upon enrollment, a member chooses a primary care clinic that
is part of a care system. A care coordinator from that care system is
then assigned to that member. Each member and his/her family has a care
team: the care coordinator (who is primarily responsible for coordination),
the primary care physician (PCP), a UCare liaison nurse, and a county
or nursing facility representative. Teams meet on a situation basis. The
success of the care team has thus far depended on the persistence of the
care coordinator in reaching out to providers, especially physicians.
Most care coordinators are registered nurses (RNs) based in the clinics; a few work
directly for the MCO. Care coordinators do not need prior authorizations
for services from UCare but do need physician approval. Caseload varies
from 75 to 150 members.
Care coordinators are responsible for:
- In-home assessments (upon enrollment and every 6 months afterward,
using a tool developed by the National Chronic Care Consortium).
- Development of a care plan (with input from the beneficiary, the caregiver,
and others on the care team).
- Access and coordination of services (including through transitions).
- Serving as the primary contact for members and their families.
This care coordination has resulted in the improved ability to care for
the member in the most appropriate setting. For members residing
in nursing homes, care coordinators focus on medical services; social
services are handled by the nursing facility itself. For members in the
community, care coordinators focus on both medical and social services.
National Chronic Care Consortium. Case management for the frail elderly:
a literature review on selected topics. Bloomington (MN): Minnesota Department
of Human Services, Minnesota Senior Health Options Project; 1997 Oct.