Emerging Practices in Medicaid Primary Care Case Management Programs. Organizational Structure


Advice on organizational structure emphasized the need for sufficient state investment of personnel and resources:

  • The state investment must be long-term for the PCCM project to show results; building the right infrastructure is an ongoing process and was often more difficult than expected.
  • Dedicate significant internal resources with multiple staff who can respond to questions and concerns from members and providers. Locating these staff at the local level will increase buy-in, as their knowledge of community services makes them more effective resources for providers and members.
  • Consider how local communities can be empowered to change the service delivery system. Partnering with localities takes a long time and creates a great deal of work, but the resulting program can be very successful.
  • In contracting with a plan administrator, include an adequate reimbursement rate in order to be able to expect best practices.

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