Coordination of Care for Persons with Disabilities Enrolled in Medicaid Managed Care: A Conceptual Framework to Guide the Development of Measures. VIII. WHAT STRUCTURES ARE NECESSARY TO SUPPORT THE CONSISTENT AND HIGH QUALITY IMPLEMENTATION OF CARE COORDINATION PROCESSES AND TO ACHIEVE INTERMEDIATE OUTCOMES?


On a more practical level, there are also specific structures and resources that appear necessary (if not sufficient) to support effective care coordination. The literature and our conversations with experts (Coleman 1979; Devers 1995; Master 1996; Saltz 1996; Watson 1997; Fox 1998; Curtis 1999; Gill 1999; Schneider 2000; Clayton, personal communication) include extensive discussions of the following elements:

  1. Existence of a strategy to identify persons with disabilities (and desire) in need of care coordination.

  2. Specification of the scope and objectives of care coordination in contracts between state Medicaid agencies and MCOs.

  3. Specification, in states which carve out critical clinical services such as behavioral health, of mechanisms to achieve and ensure coordination between carved out services and those covered in Medicaid managed care contracts.

  4. Adequate funding of care coordination activities, by the state Medicaid agency and by the MCO (as reflected in staffing levels and caseloads and other investments).

  5. Use of financing tools such as risk adjustment to provide incentives for MCOs and providers to devote resources to care coordination and to care delivery for people with disabilities.

  6. Specification, by the MCO, of the assignment of care coordination roles to its central staff and to clinical and other staff of its contracted providers and of the reporting and informing relationships between primary care coordinators and others. For instance, who is responsible for transferring information and how soon should it be available.

  7. Structural placement of care coordination functions in a unit whose primary goal is NOT cost containment or utilization management.

  8. Systems in place to ensure the timely flow of information between and among all providers (including care coordinators) caring for a particular patient, with appropriate privacy protections in place.

  9. Availability of "24/7" emergency/crisis support from specially trained clinicians or care coordinators for people with disabilities identified as in need of care coordination.

  10. Provision of specialized education and training to providers and MCO staff with respect to the special (and non-special) needs of people with disabilities, and the goals and operations involved in care coordination for this population.

  11. Creation of teams, education of consumers, care conferences and other methods for enhancing information flow and "mutual adjustment" of providers and patients/families.

  12. Current and complete knowledge, by the state Medicaid agency and the MCO, of resources at the state and local level that are relevant to the needs of persons with disabilities.

  13. Development of memoranda of agreement/understanding between the state Medicaid agency and relevant state and local public sector agencies regarding coordination of services for people with disabilities.

  14. Development of memoranda of agreement/understanding between MCOs and relevant local and state agencies to support coordination of medical and non- medical services for people with disabilities.

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