Keywords

administrative data, care coordination, care management, case manager, children, chronic conditions, clinical risk groups (CRGs), health plan, medical home, special healthcare needs

Authors

1. Fitzgibbon, Tracy M. BSN, MBA
2. Popalisky, Jean BSN, MN
3. Myers, Kristin AA
4. Neff, John M. MD
5. Sharp, Virginia L. MA

Abstract

This study documents screening methods and services provided by health plan case managers for high need children in a Washington State health plan. Enrollees were screened to identify 315 children who had or were at risk of developing a chronic condition and were high users of health services. From this group, 46 children/families could be contacted and needed case management. Services included assessment of physical/social needs, patient education, referral to community resources, and benefit utilization. These services were different from care coordination provided in primary care practices.