What Is Care Management?
The Partnership requires that a Care Management Provider Agency, approved by the State Department of Health Care Services and independent from the insurer provide care coordination for Partnership policyholders.
Using a collaborative process, the care manager works with the policyholder, his or her family, and
physician to complete a comprehensive assessment to determine the client’s needs and resources and
develop a detailed Plan of Care individualized to meet those needs.
Plan of Care: In developing the Plan of Care, the care coordinator will consider the unique
needs of the client and recommend alternatives for how those needs can best be met. It is likely
that without the help of a care coordinator, a policyholder or family would have no idea of where to
find someone to provide the necessary care. Partnership regulations require the care coordinator
to consider how the policy benefits can help meet the policyholder’s needs, and how the needs
might also be met through other sources, perhaps through community services, or the client’s
health coverage, etc. These other sources can help reduce the out-of-pocket expenses to the
policyholder as well as help the policy benefits last as long as possible. The identification of other
sources of care can be especially important for a person who has a policy designed to pay benefits
for only one or two years. Furthermore, since the Partnership requires the care coordinator to live in
and be familiar with the community in which the policyholder resides, he or she will have a good
understanding of where the quality providers are.
Care Implementation and Monitoring: In addition to completing a comprehensive assessment
and Plan of Care, the care coordinator can also contact the caregivers and arrange for them
to be in the home to provide care at the required times, negotiate rates of payment, and monitor the
quality of the services provided if desired by the policyholder.
Last modified on:
7/10/2008 10:02 AM