Comprehensive Care Corp (fka CHCR)

[Den]

Integrated Health Care Management




Establishing Solid Partnerships and Superior Quality
Initiatives to Provide the Best Possible Outcomes for Members

Introduction
Comprehensive Behavioral Care, Inc. (CompCare) presents its disease state management program model, Integrated Health Care Management, to deliver behavioral and medical health care as a single coordinated and comprehensive service for the at-risk enrollee. As one integrated service, CompCare ensures the at-risk enrollee receives the most efficient, effective, and safe treatment consistent with best clinical practice and meeting nationally recognized standards of care.
The Program Model
CompCare's model uses care management provided by CompCare's highly skilled and experienced licensed clinicians to strategize interventions in enrollee centered plans of care.

Care management decision-making is based on CompCare's Level of Care Guidelines (LOCG) developed to determine an enrollee's appropriate level of care based on medical necessity and clinical needs.
Care management decision-making is based on CompCare's Preferred Practice Guidelines developed to establish mixed service protocols.
Care management decision-making is based on nationally recognized Clinical Practice Guidelines from the American Psychiatric Association (APA) for Major Depression, Schizophrenia, and Substance Use and the American Academy of Child and Adolescent Psychiatry (AACAP) for Attention-Deficit Hyperactivity Disorder (ADHD) to determine best practice for specific diagnoses.

IMPACT
CompCare's model uses a specially created software application, Integrated Management Products and Care Technologies (IMPACT) to track, trend, and assess enrollee quality outcomes.

IMPACT captures high risk and co-morbid conditions, consultations, and discharge planning within identified behavioral and medical disease states to focus tracking, trending, and assessment activities.
IMPACT captures clinical and coordination outreach efforts completed during care management, including contacts to the enrollee, Primary Care Physician (PCP), health plan, and other relevant stakeholders, to ensure ongoing monitoring in IHC.
IMPACT captures pre- and post- program utilization, enrollee satisfaction, and costs to provide enrollee and health plan specific reporting and outcomes.
Planned Interventions and Care Management Tiers

CompCare's model consists of four action plans utilizing four approaches for at-risk enrollees identified from health plan pharmacy usage and CompCare utilization data. The first three action plans, Awareness, Prevention, and Behavioral Support affects all at-risk enrollees while the fourth action plan, Behavioral Care Management, affects the most at-risk enrollees. Within Care Management are four tiers based on severity of risks associated with Cost, Utilization, Compliance, and Quality.

Awareness Plan
CompCare's Awareness Plan provides educational information to outlier prescribers* of behavioral health medications to increase their awareness of inappropriate or ineffective use of one hundred-ninety (190) different behavioral and addictive pain medications, redundant prescriptions, lack of coordination among prescribers, and discontinuation of treatment for enrollees. Educational materials include individualized detailed and summarized enrollee reports, prescriber comparison reports, and references to nationally accepted practices. The Awareness Plan also provides educational information to enrollees identified at-risk to increase their awareness of potential health problems related to poly-pharmacy, inappropriate use or non-compliance with medication regimes and issues of co-occurring behavioral and medical disorders. We are able to track, trend, and report on educational information provided to enrollees.

*Includes Primary Care Physicians (PCP), Family Practice Physicians, Hospitalists, Pediatricians, Medical Doctors (MD), Doctors of Osteopathy (DO), Psychiatrists, and Nurse Practitioners (ARNP).

Prevention Plan

CompCare's Prevention Plan provides primary, secondary, and tertiary prevention for at-risk enrollees.

The focus of primary prevention is to remove or lessen the risk factors and to enhance enrollees' self-care.
The focus of secondary prevention is to identify problems early and to receive prompt treatment for an illness or disorder to reduce its frequency or duration.
The focus of tertiary prevention is to reduce impairment or disability following the development of an illness or disorder.
CompCare offers outreach to at-risk enrollees through telephonic and written contacts to discuss at-risk issues specified in the enrollees' educational materials. These contacts are made by well-trained and experienced CompCare staff to allow enrollees the opportunity to ask questions, clarify misinformation, and discuss their needs for the right treatment, at the right time, and at the right level of care. CompCare is able to track, trend, and report on contacts to enrollees.

Behavioral Support Plan
CompCare's Behavioral Support Plan provides treatment coordination with at-risk enrollees and relevant stakeholders in their care to ensure both behavioral and medical needs are met.

CompCare coordinates the enrollee's treatment by calling the enrollee, relevant stakeholders, including the PCP, health plan, and/or behavioral prescribers and/or therapists, to communicate treatment needs identified by the enrollee, stakeholders, or CompCare, to set up consults, and assist in resolving any barriers, i.e., lack of benefits, transportation, etc. Communication ensures care is safe, appropriate to need, timely, unduplicated, and costs are well managed. Calls made to the enrollee and stakeholders are entered into IMPACT and allow CompCare to track, trend, and report coordination of care.

Behavioral Care Management Plan
CompCare's multi-tiered Behavioral Care Management Plan is the clinically-driven care management of individual enrollees identified by CompCare to be most at-risk. CompCare uses the clinical expertise and experience of licensed behavioral health clinicians to quickly intervene at increasing levels of intensity to achieve the "best" outcomes for the enrollees regarding cost, utilization, compliance, and quality and promotes self-care, safety, and maximum bio-psycho-social functioning.

Tier 1- Low Risk Care Management At-risk enrollees with Low Behavioral-Low Medical cost and utilization are categorized into Low Risk Care Management. CompCare uses select network providers to meet these enrollees' needs for coordinated services of behavioral medications and therapy and communicating with the PCP or relevant stakeholders.
Tier 2- Medium Risk Care Management At-risk enrollees with Low Medical-High Behavioral cost and utilization are categorized into Medium Risk Care Management. CompCare uses select network providers to meet these enrollees' needs for coordinated services of those under Low Risk and additional attention to discharge planning and after care from inpatient hospitalizations, living arrangements, transportation, and medications. This plan will arrange for an appointment within seven (7) days after discharge with a behavioral and/or medical professional to assess their health status.
Tier 3- High Risk Care Management At-risk enrollees with High Medical-Low Behavioral cost and utilization are categorized into High Risk Care Management. CompCare Care Managers provide telephonic contacts to the enrollees and PCPs/health plans to meet these enrollees' needs for coordinated services of those under Low and Medium Risk and additional attention to co-occurring behavioral and medical issues.
Tier 4- Extreme Risk Care Management At-risk enrollees with High Medical-High Behavioral cost and utilization are categorized into Extreme Risk Care Management. CompCare Care Managers provide telephonic and on-site contacts to the enrollees and PCPs/health plans to meet these enrollees' needs for coordinated services of those under Low, Medium, and High Risk additional attention to co-occurring behavioral and medical issues.



Conclusion
Through innovative management practices, CompCare's Integrated Health Care Management Program, in collaboration its health plan partners, provides the most effective, efficient, and safe care for at-risk enrollees while increasing their overall well-being and decreasing their overall health care costs. Moreover, CompCare's program strongly supports enrollee outcomes for health plan accreditation initiatives and state required quality improvement activities.


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