Components of Care Management

As a result of the potential financial risks in a Medicare HMO program, a care management program is essential to the HMO, contracting physicians, and hospitals. In a care management program, the medically complex and frail older adult members are identified immediately after enrollment, and receive intensive case management services designed to improve or maintain their functional and health status.

Note: HCFA regulations prevent screening of members prior to enrollment to prevent discriminatory enrollment practices.

Basic components of a Medicare care management program:

  1. Coordinates clinical care, family concerns, and community resources for high-risk patients by a team of health care professionals

  2. Addresses medical, social, and psychological needs of the frail older patient

  3. Focuses on early intervention, prevention and cure of diseases

  4. Involves the use of multiple health professionals or a team approach to care

  5. Focuses on achieving the highest functional status for the patient

  6. Ranges in intensity from a single contact with the patient for a service like meals on wheels, to an integrated medical and social care plan with frequent patient monitoring by a member of the health care team TEAMS00000004.gif.