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Care Management Entities

A Service Delivery Strategy for Colorado’s System of Care

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An organizational entity that serves as a centralized accountable hub to coordinate all care for youth with complex behavioral health challenges who are involved in multiple systems and their families (Center for Health Care Strategies, Inc., 2011).

What is a Care Management Entity?

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• Improve clinical and functional outcomes• Enhance system efficiencies and control costs• Foster resiliency in families and youth

By:

Goals

Improving access to

appropriate services and

supports

Reducing unnecessary use of high

cost services-out of home and

lengths of stay

Using health information technology to support

service decision making

Engaging youth and families as partners in own care

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Children and youth with severe

behavioral health challenges

In or at risk of residential placement

On multiple psychotropic medications

In, or at-risk of involvement with, child

welfare

In other out of home settings, e.g.,

therapeutic group homes

Frequent emergency room visits or admissions to

psychiatric hospitals

Population of Focus

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High quality wraparound Screening, assessment and clinical oversight Intensive care coordination Information management, including real time

date Access to family and youth supports/advocacy Access to crisis supports Development of provider networks including

natural and culturally relevant supports

Functions

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Utilization management and quality improvement Outcomes management Training for CME staff, providers, families and

referring entities Case monitoring and review

Functions (cont’d)

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All families and youth should have access to peer support.

Each of the existing care management entity models, e.g., NJ, MD, Dawn Project, Wraparound Milwaukee, includes a partnership with a family/youth support organization.

Family and Youth Support

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Public Agency New nonprofit with no other role

Existing nonprofit that delivers direct services

Nonprofit HMO

Nonprofit with direct service that formally

partners with community organization

Types of Organizations That Can Serve as CMEs

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Medicaid Options

Child Welfare- Title IV-E Waiver

Juvenile Justice

Mental Health and Substance Abuse

Education

Others

Financing Streams

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• Improved Clinical and Functional Outcomes• Significant Cost Savings

• Promotes Health Homes Concepts• Supports Comprehensive System of Care Approach

Examples from states/communities:

Reduction in placement disruption in child welfare from 65% to 30% (Milwaukee)

60% reduction in recidivism rates for delinquent youth/1 yr. (Milwaukee)

School attendance for child welfare-involved children improved from 71% days attended to 86% attended (Milwaukee)

Reduction in psychiatric inpatient days from 5000 days per year to less than 200 (Milwaukee)

30% net reductions in Medicaid spending-decreases in PRTF and inpatient with increases in TCM and home and community services (Maine)

Outcomes

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Children and adolescents with a serious emotional disturbance who are in, or at imminent risk of, placement in institutional care. Institutional care is defined as a living situation for 10 or more children including, but not limited to, residential treatment facilities.

Colorado Population Of Focus

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Care Management

Entity

Family and Youth Support

Organization(Peer Support)

System of Care Values and Principles

Trauma-Informed Integrated Service and Support Delivery Model

DRAFT

Behavioral Health Transformation Council

Local Guiding Group

State Oversight Body

(Committee of BHTC)

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Feedback

Common Standards with local delivery-different variations on state. regional, community

Use existing regions i.e. BHO, RCCOs

Consumer Voice at all phases

Legislation informed by demonstration site

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Analysis of various care management models – Tracy Kraft-Tharp

PowerPoint by Bruce Kamradt, Wraparound Milwaukee

Care Management Entities: A Primer - Sheila Pires

Model

Resources

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Sheila Pires, Partner, Human Service Collaborative

Bruce Kamradt, Director, Wraparound Milwaukee

Tracy Kraft-Tharp, Co-Project Manager

Acknowledgements