The La Care Health Homes Program is dedicated to improving the health outcomes of its members through comprehensive and personalized care management. This program utilizes the expertise of care management professionals to evaluate member needs and deliver tailored interventions. By applying clinical knowledge and experience, care managers play a crucial role in ensuring that members receive the necessary support to navigate their healthcare journey effectively.
Care managers within the LA Care Health Homes Program are responsible for evaluating information from various sources, including health risk assessments (HRAs), risk stratification data, and referrals from providers and member services. This thorough evaluation process determines whether care management intervention is necessary to address a member’s specific health needs. The goal is to proactively identify individuals who would benefit most from care management services and ensure timely support.
For members with complex and significant healthcare needs, the LA Care Health Homes Program provides intensive care management services. This involves engaging in member-centric communication with interdisciplinary teams, healthcare providers, and family members or authorized representatives. Care managers meticulously review member claims histories to identify opportunities for intervention and adhere to professional standards of practice. They conduct thorough assessments, including baseline evaluations, self-care ability assessments, and comprehensive clinical evaluations as needed. A key outcome of these assessments is the development of a member-centric plan of care, specifically designed to meet individual needs and goals.
A significant aspect of the LA Care Health Homes Program is the focus on members with advanced chronic conditions, co-occurring mental health and substance abuse issues, and complex social challenges. Care managers manage an assigned caseload, prioritizing the highest-risk members within these categories. This targeted approach ensures that resources are allocated effectively to those who require the most support. Collaboration is central to the program’s success, with care managers working closely with primary care physicians and other treating professionals to ensure coordinated and holistic care.
Furthermore, care managers in the LA Care Health Homes Program play a vital role in empowering members through education and resource provision. They offer comprehensive guidance on accessing services, understanding in-network utilization, and adhering to national guidelines for care. Members are also connected with valuable community resources and equipped with self-management skills and strategies to take an active role in their health. By building strong relationships with members and their representatives through effective engagement techniques, care managers encourage informed decision-making and active participation in healthcare.
To ensure seamless support, care managers within the LA Care Health Homes Program notify Care Coordinators and Community Health Workers (CHWs) about member needs. This includes the need for educational materials, reminder calls, satisfaction surveys, and other program-specific services. This collaborative approach extends to community settings, where care managers conduct field assessments and care coordination functions at locations such as LA Care Community Resource Centers, medical clinics, and member homes. This community-based approach enhances accessibility and ensures that members receive support in environments convenient and comfortable for them.
In conclusion, the LA Care Health Homes Program, through its dedicated care management services, offers invaluable support to members, particularly those with complex health and social needs. By providing personalized care plans, fostering collaboration, and empowering members with knowledge and resources, the program significantly contributes to improved health outcomes and a better healthcare experience for the LA Care community.
