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HLCCompendium
HLCCompendium
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NDHI<br />
NAT IONAL DIALOGUE FOR<br />
Healthcare Innovation<br />
The Complex Community Care Initiative offers a personalized<br />
approach to complex care management:<br />
• Individual case reviews are completed to identify<br />
themes and patterns<br />
• Each patient is assigned to a case manager who<br />
conducts face-to-face interviews in the<br />
member’s home<br />
• Patients are connected to care teams to manage<br />
their complex needs<br />
The Complex Community Care Initiative continues to<br />
be improved through an iterative design approach.<br />
Based on the results of testing and review of the most<br />
recent iteration of a design, changes and refinement<br />
are made to continuously improve the program.<br />
Value Delivered<br />
BCBST has developed a methodology to measure<br />
the short-term cost impact of the program, based on<br />
the number of inpatient medical admissions for 2016<br />
compared to their previous two year history.<br />
While it is too early to tell whether BCBST has lowered<br />
overall costs, the program has:<br />
• Improved its member engagement rate significantly<br />
without any increase to staffing<br />
• Enabled BCBST to target its case management<br />
resources to members with the highest needs and<br />
highest potential impact of intensive care management<br />
• Increased patient satisfaction by providing a person-centered<br />
approach to care<br />
Path Forward<br />
The immediate next steps for the Complex Community<br />
Care Initiative are to continue delivering care to the<br />
initial study group and maintain tracking of this population<br />
to determine cost savings, care improvement,<br />
and other metrics.<br />
In the long term, BCBST intends to expand this approach<br />
to its Long Term Services and Supports (LTSS) and<br />
Dual Special Needs Medicare Advantage plan in 2017.<br />
BCBST has also developed a “Real Time Radar”<br />
process to identify individuals beginning to “superutilize”<br />
inpatient medical services, so that those individuals<br />
can be enrolled in the new case management model.<br />
The Complex Community Care Initiative is well organized<br />
to facilitate future improvements in care delivery<br />
models, and BCBST is working with both hospital-based<br />
providers and primary care teams toward this goal.<br />
Some future improvements include:<br />
• Integration of medical and behavioral health professionals<br />
within the health plan, primary care system,<br />
at home, and the community<br />
• Development of locally-tailored coordination teams,<br />
based on standard design, but with regional expressions<br />
that reflect existing community and provider<br />
assets<br />
• Enhancement of information systems to allow for<br />
timely automated reports, in lieu of manual tracking<br />
and trending<br />
In order for the program to expand and flourish, BCBST<br />
intends to collaborate with the Bureau of TennCare and<br />
other Medicaid MCOs. Together, they would be able<br />
to assess population health management reporting<br />
requirements to better reflect interventions that are<br />
proving to be successful. BCBST hopes to help federal<br />
and state government leaders identify opportunities<br />
for benefit redesign to provide more stable care and<br />
lower costs for vulnerable populations.<br />
Complex Community Care Initiative<br />
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