Health Plans

Health Plans

Controlling utilization of the Emergency Department is a stewardship issue for communities and health plans.

High utilization has been primarily identified as a Medicare/Medicaid issue, but commercial plans also struggle to find a solution. Regardless of coverage, most patients with high utilization face complex social issues. For these people, accessing shelter, food and other basic needs take priority over access to health services. Consistent Care case management staff are able to work alongside your patients right in the community – in the home, at shelters, and even in the ED. Our priority is to address these unmet needs to get to the root of their high ED utilization.

Reaching this transitory population can be extremely difficult for health plan case management, who highly depend on remote engagement with patients and services. Consistent Care employs community health workers who are solidly embedded in the areas they serve and work as “boots on the ground” to reach patients and collaborate with local agencies for a holistic, patient-centered approach to care.

We contract with health plans to deliver this unique case management approach to addressing high ED utilization in the areas we serve. A one-time fee based on a patients utilization is charged per member. A smaller annual renewal fee is charged in subsequent years.

As a health plan partner with Consistent Care, we can help you reach your most challenging patients in new ways. We welcome collaboration and exploration as we continue to grow both geographically and in terms of the services we offer. We are available to provide a presentation upon request here

Click here for health plan report login.

 

04

Patient Referral

Upon presenting to the ED, frequent users are identified by the existing health information exchange and referred by ED staff or health plans to Consistent Care.

 

 

05

Enrolling in Consistent Care

Consistent Care RN case managers evaluate patient medical history to determine eligibility and identify patient drivers and social determinants of health.

 

 

02

Patient Contact and Education

Case management team members connect with patients to address barriers to access, educate about alternative services, and to ultimately reduce inappropriate use of the ED.

 

 

01

Local Community Engagement

Patients are connected to social resources during monthly meetings that foster collaboration between agencies and engage the community in case management.

 

 

03

Care Plan Creation

ED-specific care plan guidelines detailing patient drivers and their prescribing and care recommendations are integrated into the existing ED health information exchange.

 

 

08

Follow Up by Following Through

Unlike other case management services, Consistent Care client advocates live and work in the same communities as their patients and are able to act as “boots on the ground” to follow up with patients through outreach visits and personalized case management.

 

 

07

Future ED Visits

Consistent Care ED-specific care plan is received immediately in the ED if patient returns.

 

 

 
06

Care Plan Updated

Care plans are regularly updated to reflect changes in recommendations.

 

 

09

Reduction Goal

For most of our clients, we establish a goal of 50% reduction of inappropriate ED use within 90 days, secondary to the resolution or management of their known drivers.