health plans

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Controlling over utilization of the Emergency Department is a stewardship issue for communities and Health Plans. This is primarily a Medicaid and Medicare issue, but even commercial plans struggle to find a solution. Regardless of the coverage, most clients with high utilization face complex social issues.

 

For this group accessing shelter, food and other basic needs take priority over issues such as access to primary care or routine dental care. Innovative programs like the Consistent Care Program are able to work alongside clients in the community; sometimes at shelters or right in the ED to offer assistance in addressing these unmet needs so that ultimately they can address the problem that is leading to their high ED utilization.

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The Consistent Care program employs Community Health Workers, Registered Nurses and Social Workers that are solidly embedded in the areas they serve, sometimes working directly in the ED. Reaching this transitory population can be extremely difficult for health plan Case Management, who depend mainly on telephonic contact to engage members.

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The Consistent Care program (CCP) contracts with health plans to deliver this unique Case Management approach at addressing over utilization in the areas we serve.  A one-time fee based on a clients utilization is charged per member.  A smaller annual renewal fee is charged in subsequent years.  

 

The CCP is open to exploring new models for delivery of our services. With health plan support it is feasible to begin a program in areas that we are not yet established.  We are open to discussing bringing our program  to new areas. The CCP has steadily proven a 50% reduction in ED visits.