Special Interdisciplinary Care-Complex Case Management

Special Interdisciplinary Care-Complex Case Management

Background:

YourCare Health Plan has developed an enhanced model of care management for a targeted population of managed Medicaid members. The model of care is called SPecial Interdisciplinary CarE (SPICE). The success of this program will be measured by improved member outcomes, enhanced member and provider satisfaction, and optimal resource utilization resulting in cost effective care.
With New York State’s Medicaid reform, the Medicaid Managed Care population now includes a greater number of individuals with complex medical and behavioral health problems that have significant socio-economic challenges. Many of these individuals receive sub-optimal, expensive and uncoordinated care or no care at all. 
Effective care management programs for this complex population must be member-centric, directed by a multifaceted team of health care professionals, supported by evidence based care, and integrated with other health services programs.  


Team Structure:

Each high risk individual is assigned to a SPICE Team which consists of a RN, LMSW and outreach worker. The team is supported by a multidisciplinary group including a board certified physician, a clinical pharmacist and a nutritionist who have input into  the development of the care plan. Behavioral Health and community support are added when needed. Communication between the team, the patient and the PCP helps provide optimal, coordinated care.


SPICE Program:

This effective program is member-centric and member directed offering collaborative outreach from a multi-faceted team of professionals keeping the PCP in the fore front of the care continuum. The care plan and interventions are  individualized to meet the member needs. This is a high touch, high frequency outreach.


Program Goals:

Improve the overall health of the member by delivering optimal  cost effective care in the right setting, helping members develop self management skills to better manage their health and improve communication between the member and the healthcare team.