PP108 – Dual Case Management for Medically Complex Members in Managed Medicaid
Delaware Medicaid consumers receiving Long Term Services and Supports (LTSS) can be among the most complex populations to work with. In Delaware a subset of this group receives Private Duty Nursing to assist them in remaining in their homes surrounded by family and their personal belongings. The Highmark Health Options (HHO) LTSS Case Management department services around 5,200 members across Delaware’s three counties. Members receiving Private Duty Nursing face many additional challenges due to comorbid health conditions, lack of skilled staffing in the home due to the nursing shortage, and multiple specialist appointments which can take up much of their day and at times much of their week. HHO’s approach to helping our members live their lives to the fullest is to provide dual case management to LTSS members receiving Private Duty Nursing services. These members are case managed by both a nurse and a social worker so that all aspects of their care are managed by individuals with expertise in physical health and psychosocial determinants of health. This innovative approach not only assists our members in managing their medically complex conditions more effectively, but also minimizes case manager burnout and encourages teamwork. The management structure incorporates elements of escalation and rounding so that case managers are supported in their work and receive real-time guidance and ideas as they navigate the challenges and everchanging landscape of health care. The additional health plan benefits made available through the LTSS program help members to remain in the community, but it is the skilled interventions completed by the case manager that foster client self-determination and person-centered care planning. Nurses and social workers have unique expertise that when combined fully realize the goals of the “Triple Aim” which when working for an organization charged with stewardship of the state’s Medicaid dollars makes for an effective approach.