Key Highlights
- Enhanced Care Management (ECM) offers personalized support for individuals with complex health and social needs.
- ECM is a free service for eligible Medi-Cal members.
- Care teams work closely with members to develop tailored care plans, ensuring their unique needs are met.
- Care goes beyond traditional healthcare by addressing social determinants of health, such as housing, transportation, and food security.
- By providing comprehensive support through ECM services, Presidium Health empowers members to achieve better health outcomes, enhance their quality of life, and navigate the complexities of the healthcare system.
- Presidium Health provides ECM and Community Supports (CS) services across California, including: Los Angeles and San Diego counties along with the Inland Empire.
Introduction
Enhanced Care Management is an innovative approach to comprehensive care management spearheaded in California. The population of focus this special program is designed for are people at the intersection of complex needs and poor resources. These individuals benefit from whole person care, with detailed support to manage their health and well-being. The ECM program takes this full approach to health for eligible members. ECM lead care managers understand that health is not just about medical care, it also includes social factors that affect health.
ECM Benefits for Members in California
An ECM provider like Presidium Health, aims to offer many benefits to populations of focus. Types of services go beyond regular healthcare by focusing on both medical and social needs in an intensive coordination of health for qualified members. This all-around approach helps boost health results. It also encourages people to take part in their own health promotion, ultimately leading to better quality of life. Here are some of the benefits of combining physical health, mental well-being, and social support services with a dedicated lead care manager. all connect to shape overall health.
Personalized Care Plans Tailored to Each Member
ECM benefits include personalized care management plans based on detailed assessments. Health care should not be the same for everyone. That’s why Presidium Health focus’ on each member’s needs and goals.
Each member has a single lead care manager. This person is a main contact and helps guide them throughout their healthcare journey. This close relationship builds trust between the member and their care team. Together, they make decisions and keep chatting. This way, Enhanced Care Management helps members take charge of their health, which leads to sticking to care plans and better health results.
Coordination of Care Among Multiple Providers
Many people with complex needs struggle to move through a tricky system of healthcare providers and specialists. This divided care can cause confusion, mixed-up treatment plans, and worse health results. ECM helps solve this problem. It provides smooth coordination of care between different providers in a member’s healthcare journey.
The lead care manager acts as a middleman. The lead care manager helps with communication and teamwork among primary care doctors, specialists, hospitals, and other healthcare providers. This team-focused approach makes sure that everyone involved in the care process understands each other. They work together to give patients the best care possible.
Direct Support and Advocacy for Members
Navigating the healthcare system can be tough, especially for people with complex needs. It can bring extra challenges. ECM knows how important it is to offer caring support and strong advocacy. They want to help members during their healthcare journey.
Care managers serve as trusted guides. They give members and their families help, facts, and emotional support. They explain health conditions, treatment options, and rights in the healthcare system.
Improved Access to Healthcare Services and Resources
Access to timely and right healthcare is very important for your health. Yet, people with complex needs often face problems that make it hard for them to get the care they need. Often, to get assistance with complex needs we are left depending on the emergency department. ECM works to remove these problems by linking members to many healthcare services and resources.
ECM also understands that social determinants of health play a big role in getting good care. That’s why care managers work hard to connect members with community supports. These could be things like help with transportation, housing programs, and food banks.
Enhanced Support for Managing Chronic Conditions
Chronic health problems need regular care and support to avoid issues and keep people healthy. ECM is important in helping individuals manage their chronic conditions and live better lives.
With regular check-ins, help with managing medications, and teaching self-care skills, ECM gives members the tools they need to take charge of their health. By tackling problems that might stop them from getting care and offering personalized help, ECM supports members in gaining better control over their conditions. This reduces the chances of complications and hospital stays.
Assistance with Navigating Health and Social Services
Navigating the world of health and social services can be very hard. This is especially true for people with complex needs. ECM helps members find the support they need to use these important services well. They understand that social needs affect health. So, ECM goes further than just healthcare. They also focus on social factors that can really impact a person’s well-being.
Care managers help members connect with local organizations. These groups offer support in areas like housing, work, and transportation. By focusing on these key needs, ECM helps members live healthier and more satisfying lives.
Proactive Outreach to Promote Preventative Care
Prevention is better than treatment. ECM focuses on reaching out to help its members with proactive care. Regular health checks, vaccines, and early treatment plans are important to stay healthy and stop diseases from starting or getting worse.
Care managers contact members to help them book appointments. They also provide useful information about preventive care and discuss any worries or challenges members might face. By promoting this proactive health approach, ECM helps its members spot potential health problems early.
Eligibility Requirements
ECM doesn’t apply to everyone, so who exactly benefits? The program primarily targets Medi-Cal members facing a range of health or social challenges. Individuals in the following groups are often eligible for ECM:
- People with Complex Medical and High Utilization Needs: This includes those managing chronic diseases, frequent hospitalizations, or ongoing medical treatments.
- Individuals Experiencing Homelessness: ECM helps connect unhoused individuals with housing support and health resources.
- Individuals Transitioning From Incarceration: With specific challenges to navigate, Adults and youth benefit from tailored care coordination when transitioning from incarceration.
- Patients with Mental Health or Substance Use Disorders: ECM provides an integrated approach to clinical and non-clinical support.
- Nursing Facility Residents Looking To Transition Back To Community: Managed care plans can off member services addressing transitions of care. These extra services ensure any additional needs are addressed proactively to accentuate the member experience during a complicated period.
If you’re wondering whether ECM applies to you or someone you know, visiting resources like the Department of Health Care Services can provide additional clarity. For providers, this Blue Shield of California Promise Health Plan guideexplains more about the program’s scope and implementation.
By addressing diverse needs, ECM serves as a lifeline for individuals who might otherwise fall through the cracks of traditional healthcare systems. This targeted approach ensures those who need help the most are prioritized, enabling a healthier and more stable life for all participants
Conclusion
Enhanced Care Management helps meet the healthcare needs of members in a complete way. They provide personalized care plans and reach out early for preventative care. ECM supports people in managing long-term health issues and understanding health services. This service makes it easier to work with different providers, which helps access resources and support.
Frequently Asked Questions
What is Enhanced Care Management (ECM)?
Enhanced Care Management is a complete way to take care of health that aims to help patients with complicated medical needs. It includes making personal care plans, working together with healthcare providers, and offering support services. This approach helps improve the well-being of patients.
Is There A Fee Associated With This Service?
Enhanced Care Management services are usually offered for free to those who qualify. Health plans often pay for these services. This helps members take charge of their health. It may also help them avoid more expensive care later on.
What Social Services Are Provided?
Enhanced Care Management helps provide social services. These include housing, food, transportation, and help with finding jobs. The goal is to meet social needs that affect health and well-being. This is especially important for people facing ethnic disparities or economic challenges.
Does ECM Help With Employment?
Yes, Enhanced Care Management can help with finding jobs. This support is part of how they focus on social determinants of health. They may offer advice on careers, refer you to job training, and assist with searching for jobs. Their aim is to help members feel more stable and healthy.
Does ECM Help With Housing?
Yes, ECM usually offers housing support as part of its social services. Care managers can help connect members to community resources, housing programs, and advocacy services. This support is to help deal with housing problems and prevent homelessness.
Does ECM Help With Food And Other Resources?
Yes, ECM helps fight food insecurity and meets other resource needs. It connects people with community supports. This can include guiding them to food banks, meal help programs, and assists with signing up for benefits.
Does ECM Help With Transportation
ECM often offers transportation services. It helps connect people with programs that provide transportation aid. This support makes it easier for individuals to go to medical appointments. It also allows them to reach community resources. This way, they can improve their overall health and well-being.
