How safety-net health plans are improving care delivery and outcomes

A new fact sheet released by the Association for Community Affiliated Plans shows that safety-net health plans use various resources, such as comprehensive assessments, individualized care plans, enrollee and provider incentive programs and greater use of emerging technologies, to engage members and providers.

The paper, authored by The Menges Group, examines programs from four safety-net health plans. They are Children's Community Health Plan, a Medicaid managed care organization affiliated with Milwaukee-based Children's Hospital of Wisconsin; Priority Partners, a Maryland Medicaid MCO owned by John Hopkins HealthCare and Maryland Community Health System, both based in Glen Burnie; Denver Health Medical Plan; and Tarrytown, N.Y.-based Hudson Health Plan.

Here is how each plan is improving care delivery and outcomes, based on the report:

1. Children's Community Health Plan instituted a prenatal care coordination program, Healthy Mom, Healthy Baby. The program features in-person and group meetings, education, goal-setting, community events and online support groups. The result has been a lower proportion of premature births and higher rates of immunizations and breastfeeding.

2. Priority Partners uses the Partners with Mom program to deploy case managers and community health workers to coordinate care for pregnant members. Program participants have seen a lower rate of preterm births between 24 and 30 weeks, fewer NICU admissions, and were more likely to receive recommended care. 

3. Denver Health Medical Plan's Complex Case Management Program connects members to a case manager who strives to address the member's physical, social, behavioral and other needs. One of the program features is staff dedicated to connecting members to community resources and support, allowing case managers to focus on clinical needs.

 4. Hudson Health Plan's Integrated Case Management Program features the INTERMED Case Management-Complexity Assessment Grid Tool, a comprehensive assessment for members with complex conditions and high levels of medical need. Under the program, one case manager with responsibility for a client's physical, mental, psychosocial health and health system navigation without the transfer of the case to another case manager.


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