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Anatomy of a Proactive Case Management Team

A need to expand led CareOregon to create new roles and responsibilities for its interdisciplinary case management team, such as a 'healthcare guide,í explains Rebecca Ramsay, BSN, MPH, senior manager of care support and clinical programs at CareOregon.

Our program has been developed to identify at-risk populations and to make a broad impact. We have teams that are formed with nurses, behavioral health specialists and a unique role called the care support healthcare guide. Early in program development, we realized the kind of depth we wanted to create in our program was going to require more program capacity than we had in the past. About six or seven years ago, our program consisted primarily of nurses who were working independently and doing crisis management. They would talk about how they were chained to their phones, couldnít do anything besides respond to the tyranny of the urgent and didnít have any team members to help them.

We hired five behavioral health specialists who are primarily licensed clinical social workers, and we developed a new role called the healthcare guide — a paraprofessional case manager who often has a medical assistant certificate or a certified nursing assistant (CNA) training. We have a few pharmacy technicians, and they are paired with a clinician, a nurse and a behavioral health specialist. They do care coordination, service coordination and engagement work with our members. These teams are then aligned to primary care practices. A team might have 15 different primary care practices that are geographically located in a similar place in Oregon. Any member who is assigned and being seen in those clinics has been a part of the population of patients for which the team is responsible.

Since we wanted to focus on building proactive strategies, we took some of the team members and created a proactive outreach team. There are one or two nurses for behavioral health specialists, and about five healthcare guides who are part of that team. Their sole responsibility is to take in information from our predictive modeling system and health risk assessments (HRAs) that we do for new members and use that information to reach out to members.


Source: Best Practices in Contemporary Case Management, April 2011

Best Practices in Contemporary Case Management

This resource examines three separate case management initiatives as well as the impact of these programs on health outcomes, care delivery and resource utilization. It provides the details on case management programs being utilized at Sutter Health Sacramento Sierra Region, CareOregon and Lutheran Medical Center.

Best Practices in Contemporary Case Management is available from the Healthcare Intelligence Network for $127 by visiting our Online Bookstore or by calling toll-free (888) 446-3530.

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