What is Innovative Care Partners?
What is a Community Partner (CP)?
Community Partners are behavioral health and long term support service organizations that coordinate care for individuals covered through Medicaid/MassHealth who have severe mental illness, a developmental disability and/or the elderly who also have a history of significant medical claims and a high cost of care. The purpose of a CP is to assist people from these populations in adhering to the care plans of their medical and behavioral health providers.
What is Care Coordination?
As the name implies, Care Coordination is a mechanism that ensures a patient’s overall health needs are being met, with the right care being delivered in the right place at the right time by the right person. A Care Coordination team, comprised of a multidisciplinary group of nurses, clinicians and bachelor’s level care providers, creates individualized plans to support MassHealth enrollees with complex medical, behavioral health and long term service needs. The team coordinates communication between the individual’s medical and community-based service providers and connects people to resources to help them meet their health and wellness goals.
Why is Care Coordination so important now?
Massachusetts has instituted health care reform of the Medicaid (MassHealth) care system. Effective March 1, 2018, Massachusetts established Accountable Care Organizations (ACOs) that are hospitals and other health care providers who are paid to care for entire populations of individuals on MassHealth, rather than the former per person fee-for-service system. Given the funding change, ACOs now have the financial incentive to prevent illness and improve people’s health to reduce the cost of medical care. To support these ACOs, Massachusetts has also created a system of Community Partners (CPs) to support the ACOs in these efforts.
How does ICP help ACOs?
ICP knows the MassHealth population and we are uniquely qualified to reach them with cultural competence to deliver coordination of care with human service. Enrollees with severe or multiple health conditions and functional limitations are more likely to go to hospitals, emergency rooms and long-term care facilities. They are also more likely to need supportive services to help with activities of daily living or to arrange for transportation. As a result, they are more vulnerable to fragmented care, which contributes to suboptimal outcomes. ICP leverages ACOs’ capacity for care using our organization’s capacity for care management.
How does ICP promote better health outcomes?
ICP anticipates client needs, adapts to changing circumstances, and leverages resources to promote better health outcomes, including:
- Person-centered planning focused on each Enrollee’s unique health concerns
- Individualized care management to improve follow up and follow through in care planning
- Cultural competency for better understanding of care planning and greater Enrollee compliance
- Reduced emergency room utilization that lowers the cost of non-emergency care
- Coordinated care planning that keeps the “human” in human services
Who are the organizations behind Innovative Care Partners?
- CHD (Center for Human Development): Founded in 1972, CHD is a CARF-accredited organization that provides a broad range of high quality, community-oriented human services to 17,000 children, adolescents, adults, and families each year. CHD is dedicated to promoting, enhancing and protecting the dignity and welfare of people in need. chd.org
- Gandara Center: Established in 1977, the Gandara Center provides outpatient mental health and substance use services to the growing and largely unserved Hispanic community in Western Massachusetts. The organization promotes well-being through innovative, culturally competent behavioral health, prevention and educational services. gandaracenter.org
- ServiceNet: Tracing its roots to 1965, ServiceNet serves people living with mental illness, developmental disability or autism, brain injury, or substance use or addiction issues. ServiceNet works with individuals and families, people who require continuing support, and others who need short-term counseling. servicenet.org