Integrated Case Management

Care Coordination

As medical practice becomes more complex and demanding, coordinating care between various providers involved in a patient’s care is a challenge. It is not unusual to hear from patients, "my providers don’t seem to talk to each other". Many PCPs tell us that they are unaware their patient received services from a specialist. Here are some simple steps that you can use to improve communication between primary care physicians and specialists:

• PCP offices may use original referral for specialty consultation forms as a “tickler” system. This form is filed in a “pending” drawer and only removed when the associated report has been received. The tickler file is compared against daily mail and faxes.
• Referral logs can be used in a similar fashion. These can be put into and Excel spreadsheet for easier updates and tracking.
• Consultation reports and other diagnostic information should not be filed into the medical record until the provider initials that the information has been reviewed and indicates any desired follow-up.
• Some specialists call the PCP office as they write and dictate visit notes to communicate that the patient has been evaluated. This typically is done through a messaging system, unless provider-to-provider contact is required for significant issues requiring rapid response. A written response is still important after the phone call.
• In the hospital, the doctor’s office, and at the pharmacy, patient safety is a major focus. Provider-to-provider communication plays an important role in patient safety and always enhances health care. Please do your best to improve this type of communication in your office and keep your patients safe.

Case Management

Molina Healthcare provides a comprehensive Case Management program to all health plan members who meet the criteria for services. The Case Management program focuses on coordinating the health care, services and resources needed by health plan members with complex needs and health care issues through a continuum of care. The Case Management program is individualized to accommodate and address the unique needs of each health plan member in collaboration with the member’s primary care physician and other physicians and health care professionals.

Examples of health issues that may qualify members for case management include:

• High-risk pregnancy;
• Catastrophic medical conditions;
• Chronic illness;
• Preterm births;
• Frequent visits to the Emergency Department for potentially inappropriate reasons

Complex Case Management

Molina Healthcare’s Complex Case Management program offers you and your patients the opportunity to participate. Patients who are the most appropriate for this program are members who have the most complex service and health care needs. These members may include individuals with: multiple medical conditions, high level of dependence, conditions that require health care from multiple specialists and/or who have additional social, psychosocial, psychological and emotional issues that exacerbate the condition, treatment and/or discharge plan.

The goals of the Complex Case Management Program are to:

• Conduct a needs assessment for the patient, patient’s family and/or caregiver;
• Provide intervention and care coordination services within the benefit structure across the continuum of care;
• Empower individuals to optimize their health and level of functioning;
• Facilitate access to medically necessary services and ensure that the services are provided at the appropriate level of care in a timely manner;
• Provide a comprehensive and on-going plan of care to ensure that appropriate continuity of care is provided for you, your staff, your patient and the patient’s caregiver(s).

Transitions of Care

Molina Healthcare clinical staff including case managers and social workers and other non-clinical staff like community connectors work together with physicians and other health care professionals and the community to facilitate effective and efficient transitions of care. Our health plan members access health care and services across a variety of care settings and their overall health and well-being depends how effective we all can be together to navigate the health care system.