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Dome - A model of managed care

December 2011

A model of managed care

Date: December 16, 2011

From left, Priority Partners member Tonya Brice; East Baltimore Medical Center Nurse Case Manager LaTonya Spriggs-Dailey; and Johns Hopkins HealthCare Community Care Coordinator Veda Moore.

Getting the underserved and underinsured access to providers in an appropriate and cost-efficient manner is one of the conundrums plaguing the national health care delivery system. Almost a year ago, Johns Hopkins HealthCare joined with the East Baltimore Medical Center to develop a standard for care management that preliminary data suggests could serve as a model for solving the problem. 

With its East Baltimore clinic as a base, the partnership has effectively managed the care for 11,000 patients enrolled in Priority Partners, the Hopkins Medicaid managed care organization. Through on-site case managers and outreach community care coordinators, the team encourages patients to use their primary care provider for necessary care and helps to arrange other health services in the community, such as peer-to-peer health education and mentorship outreach.

Patients receive care coordination and referrals on the spot. Additionally, community care coordinators initiate contact with at-home patients who are not accessing appropriate care or who need follow-up, going as far as to schedule home visits to keep them on track. And to date, it has been successful.

Since its start, the team has intervened with 1,500 members, and the number of members identified with high emergency department use has decreased from 32 to 18. This is because of a valuable component of the partnership that allows case managers and care coordinators to check in on those patients. “There is both education and follow-up,” says Johns Hopkins HealthCare Director of Care Management Michelle Hawkins. “When we identify these patients, we want to know why they use the ED so frequently. When we find out the why, we can help bring them back into primary care.”

This new model may prove to be an example of how to improve the health care of the underinsured and underserved while helping to reduce the costs of care.

—Katie Kuehn