Case management and behavioral health

In 2007 the HIP Health Plan of New York restructured its case management program for clients at highest risk of re-hospitalization for psychiatric conditions to capitalize on previ- ous lessons learned and advances in the field of case management. Early results, utilizing an intent-to-treat, historically controlled design, have demonstrated a 70-percent reduction in 30-psychiatric readmission rate corresponding to savings of over $500,000 in 30-day inpatient psychiatric costs.

Program Overview

Upon psychiatric hospitalization, a risk of re-hospitalization score is calculated based on an internally developed predictive model (developed by the author and colleagues). Clients scoring above a risk threshold are identified for intensive case management services (ICM). The most common diagnoses include psychotic disorders, bipolar disorder and depression. Licensed social workers contact identified clients directly and provide case management services via telephone. Services are provided with the aim of helping clients overcome barriers to condition management while promoting high-quality treatment, safety, community tenure and cost-effective outcomes.

Essential Case Management Components

The program incorporates five key components, explained in greater detail below.

1. Enrolling and engaging clients.
2. Advocacy and mobilization of community resources.
3. Providing education to clients, families and caregivers.
4. Promoting treatment adherence.
5. Assessment and monitoring of symptoms.

Enrolling and Engaging Clients

Incorrect phone numbers and address changes make finding clients identified for ICM challenging. Several strategies were implemented, resulting in an enrollment rate improvement from 33 percent to approximately 90 percent.

Rather than wait for clients to be dis- charged from the hospital before pursuing them for ICM, clients are contacted while still inpatient. By contacting the inpatient social worker or unit discharge planner, case managers arrange to speak with clients on the telephone. During this call correct telephone numbers and collateral contacts are confirmed, allowing for easier post-discharge contact.

By speaking with a client during hospitalization the case manager becomes associated with the treatment team, allowing for a smooth transition once the client is discharged. When presenting the pro- gram to clients, case managers do not emphasize the many benefits of the service but rather present case management as something to which the client is entitled, a service provided by the individual case manager. Throughout the entire process, case managers communicate empathy and concern for the well-being of all clients.