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Managed Care

Managed care is a system for providing health care benefits through the health plans for some clients enrolled in Medical Assistance (MA). SWHHS has entered into contracts with Blue Cross and Blue Shield (BCBS), UCARE, and PrimeWest Health to provide care coordination services for clients in some of their managed care programs. SWHHS provides care coordination for clients in the Minnesota Seniors Health Options (MSHO) and Minnesota Seniors Care Plan (MSC+) products, in addition to the Special Needs Basic Care (SNBC) services for the under 65 population under PrimeWest Health. Care coordination services are key to supporting the client’s needs across the continuum of care.

SWHHS begins the process of care coordination by receiving a monthly enrollment report from the Managed Care Organizations (MCOs). A care coordinator is assigned to each client to assist with his or her health care needs. Contacts are made with the client or responsible party to offer a Health Risk Assessment. This is accomplished by completing the face-to-face Long-term Care Consultation (LTCC). This consultation assists the client and care coordinator to determine if the client is in need of any service to help them remain in the community. Care coordination services involve clients that may be on the Elderly Waiver (EW) Program, a community-well client living independently in their own home, or a client living in a skilled nursing facility (SNF). At SWHHS, social workers are care coordinators mostly for those clients receiving EW services or living in the community independently. Public health nurses primarily provide care coordination services for clients in the skilled nursing facility (SNF) with the exception of Rock County where one social worker manages SNF clients.

Pipestone County public health nurses and social workers work in collaboration to provide services to the SNBC clients who are under 65 living in the community or skilled nursing facility.

The MCOs provide SWHHS with models of care, specific guidelines, and programs to follow. SWHHS is also expected to follow state policies for Home and Community Based services when the client receives EW services.

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