What is Magellan Complete Care?
Magellan Complete Care is a Florida Medicaid specialty health plan for individuals living with a serious mental illness that combines care for both a member's physical and mental well being.
Successful Communication and Working Together
Each month, the Care Coordination Team receives information about Robert's risks and gaps in care. The team identified gaps in care in medication adherence and a lack of preventive care. Additionally, on his health and wellness questionnaire (HWQ), Robert self-identified himself as having no regular physical activity.
Based on his profile, his Care Coordination Team collaborated to engage Robert in scheduling and attending preventive care appointments, reinforcing Robert's compliance with his medication treatment, and encouraging his involvement in a walking group at his local drop-in center. His Care Coordination Team also is working with him on his goals of managing his diabetes and his diet.
Recently, Magellan was contacted for authorization when Robert was hospitalized for treatment of a pulmonary embolism. As a result, his Care Coordination Team received notification and his nurse began working with the hospital's discharge planner anticipating additional behavioral health support as well as anticoagulation therapy monitoring.
His Health Guide monitored Robert's medications and intervened to facilitate communication between the internist and Robert's psychiatrist when she learned that a hospitalist reduced Robert's antipsychotic medication. Magellan's clinical pharmacist provided consultation for the Health Guide and prescribing physicians in that situation and in reviewing and reconciling Robert's medications upon discharge from the hospital, recommended a newer anticoagulant with benefits such as less frequent lab tests.
Increasing Access and Creating Goals and Treatment Plans
When Susan enrolled, a health and wellness questionnaire (HWQ) was completed, and, because of her high score (within the top 15%), she was assigned an Integrated Care Case Manager as well as a Health Guide. As part of the case manager's initial assessment, her behavioral and physical health providers communicated that Susan frequently did not show up for appointments and her providers were concerned about her lack of follow up treatment after frequent ER visits.
The Health Guide arranged a Care Coordination Team meeting with Susan and her sister. The team discovered that anxiety and her mild retardation were barriers to Susan using a transportation provider. With Susan's input, a care coordination goal was established to improve her ability to attend appointments independently. In addition, the Peer Support Specialist arranged to ride with Susan to and from her next several scheduled appointments. As a result, when Susan had a cold and cough, instead of calling 911 to go the hospital; she called her Health Guide who arranged transportation for her to get to the doctor's office.
With Susan's confidence improved it allowed for a new goal to be established - to teach Susan how to monitor her asthma and work with providers early whenever symptoms worsened. The Integrated Care Case Manager met with Susan twice at her internist's office and once at her home, reinforcing the doctor's instruction and coaching her on how to use a peak flow meter and keep a diary of her readings. Susan brought her diary to her medical appointment, and she has agreed to continue to monitor her asthma. She also has agreed to meet with a nutritionist and join a weight loss group.
Improving Whole Health with the Right Team
Mary reported on the health and wellness questionnaire (HWQ) that she has bi-polar disorder, is homeless, is a smoker and had multiple emergency room visits in the past year for heart problems. Her risk score placed her in the high-risk tiers for behavioral and physical health and thus, she will receive intensive care management support.
The Care Coordination Team developed an integrated care coordination plan to set goals related to her bi-polar disorder, tobacco use and need for on-going physical health services to monitor her heart problems. In addition, the program staff referred Mary to local community organizations that could aid in locating stable housing, engaged a Peer Support specialist to help her with medication adherence, and arranged appointments with her primary care physician (PCP). Since she often is anxious when seeing her PCP, her Peer Ssupport Specialist will attend the first few visits with her.
This page last updated: 9/2/2016 12:25:20 PM