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Serving Complex Populations With Community-Based, Person-Centric Care
October 18, 2017

Serving Complex Populations With Community-Based, Person-Centric Care

Cardinal Innovations Healthcare is the largest specialty health plan in the country, insuring more than 850,000 North Carolinians with complex needs. Using a community-based model of care management, Cardinal Innovations has led the way in developing services, processes and solutions that improve the lives of our members and their families. Recognized for operational excellence, innovative solutions and superior outcomes for members, accuracy and speed of payments to providers, and cost-effective funds management, Cardinal Innovations is a leading healthcare company in the United States.
2. Establish a community-based care coordinator model
Establishing a community-based care coordinator model can empower organizations to directly support members, families, and stakeholders where they live, work, and play. The goal is to create high-quality, high-touch care coordination that fosters person-centered care plans.
As a guiding principle, the model should be set up to understand and make use of available community resources. These might include schools, the court system, the department of social services, local physicians, and more. A strong utilization management team with deep expertise in these member populations can authorize cost-effective services in the settings of the individual’s choice.
One example is the Transitions to Community Living (TCL) program, which helps people live in their own homes instead of in adult care homes or institutional settings. The Cardinal Innovations TCL team uses a person-centered, outcomes-focused approach not just to secure community housing, but also to establish the ongoing support services each individual needs for optimal care and healthy community living.
System of Care is another example of multi-agency collaboration in which child service agencies, including child welfare, mental health, schools, juvenile justice, and healthcare, come together to support youth and their families. A recent partnership between Cardinal Innovations System of Care team, North Carolina Families United, and the University of North Carolina Charlotte School of Social Work is helping to train social work students to meet these members’ needs. 
With good community relationships, care coordinators can find the best resources for members and their families based on their wishes and in pursuit of the highest quality of life in the least restrictive situations.
3. Invest in your ecosystem
There’s no doubt that developing a managed care strategy for complex member populations requires investment—not just in technologies, but in staff, community resources, and training. The whole goal is to prepare communities to better identify and prevent health crises before they occur. 
In North Carolina, Cardinal Innovations has extended both technical and non-technical assistance to community providers to help them better understand and address the needs of its members. Provider 360, for instance, is a program that offers resources, tools, and business training to help strengthen providers’ behavioral health practices. Likewise, Community Engagement services are designed to work with local community agencies—from court systems to jails to departments of social services—on educational and customer service opportunities.    
Another example of productive stakeholder collaboration is an initiative called Partnering for Excellence (PFE). Through PFE, Cardinal Innovations and child welfare work together to provide holistic, early interventions for children who have experienced trauma. The services include trauma screening for children entering protective services, in-home and permanency services; an integrated care plan to ensure the child receives appropriate services from the start; and care management requiring Department of Social Services-involved families to work together to strengthen communication and coordination.
The investment in network providers and community agency relationships is critical. Through education and technical aid, they are better equipped to help members get the care they need before a crisis occurs—offering a more cost-effective approach to a higher quality of life.
4. Build community care collaboration 
High-quality programs depend on the ability to nurture strong partnerships within the IDD, mental health, and substance abuse provider communities. They must also recognize that the physical care of these populations is, in many cases, managed separately by multiple physicians or hospitals.
Members may have chronic health conditions such as diabetes, high-blood pressure or asthma, for example. Medication management can be a challenge in these situations. Treatment for a member’s IDD, mental health, or substance abuse disorders may interfere with the treatment for those illnesses, or cause additional side effects.
Managing the complete needs of complex member populations is a constant juggling act. To achieve success, we, as an industry, must improve coordination across the entire care spectrum, and offer a more person-centric approach through co-located clinics and other member conveniences.
One of Cardinal Innovations’ health centers is a strong example of this in practice. As an integrated care facility, it provides a gateway that connects individuals with behavioral health and substance use conditions to a continuum of health services. These include on-site primary care, outpatient services, and mobile crisis with 24/7 access to crisis services.
One key to improved quality of life for these members is to offer recovery-oriented behavioral and physical health services in a long-term and sustainable manner.
Strong focus and increased collaboration for healthier outcomes
Regardless of how a state funds and manages Medicaid services, the bottom line is that it will take an increased commitment to collaboration to contain costs while enriching the quality of life for these members.
There’s plenty of opportunity to make a positive—and lasting—change for Medicaid beneficiaries. Wrapping them in holistic, community-based services helps create the true person-centered care that is the ultimate goal—and the way to better long-term outcomes.

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