Innovation of Rurally Sustainable Integrated Care Management Model: Innovation Process and Model

Background: There are increasing calls for integration of mental health and physical health care in a marketplace where the two primarily remain siloed. Across the US, Medicaid programs have attempted to bridge this gap through care management with focus on improving patient outcomes. There is little attention paid to the workflow, processes and models that efficiently address this gap, especially important factors in rural areas that suffer from workforce and healthcare shortages.

Methods: OSU Center for Health Systems Innovation's consultants (ROK-Net) partnered with 6 healthcare agencies (7 sites) in Oklahoma, (4 rural, 3 urban). ROK-Net conducted three assessment stages (direct observation, formal assessment, and visualizations of barriers) and one innovation stage (model development), resulting in a new integrated care management model. ROK-Net reviewed program handbook, conducted interviews and attended team meetings. These informed the development of a 30-item assessment tool (Cronbach alpha = 0.89) measuring 6 program components: administrative technology, case management workload, medical team integration, population health (assessed at county level), ability to meet state requirements, and efficiency of delivery design. In addition to statistical analysis, scores were transformed into radar graphs to convey program dynamics and customize targets for individual agencies. Workflow analysis of patient journey, data, and care models identified additional inefficiencies. The new model was innovated by reorganizing staff, recombining resources, and simplifying patient journey.

Results: Statistical analysis demonstrated benefit of medical expertise and workflow analysis demonstrated a need to minimize patient burden. Efficiencies in care management were significantly correlated to the involvement level of the medical consultants (r= 0.85, p= 0.015); overall program efficiency was highly and significantly correlated with the accessibility of medical expertise (r=0.84, p=0.018). Workflow maps identified bottlenecks and duties transferred to patients. Program visualizations identified data gaps, mis-ordered tasks, and unreasonable expectations of workforce. (Visualizations will be included on poster.)

Conclusions: Innovation provides promising solutions for rural health. Workforces attempting to integrate health care face many barriers and the inclination is to resolve these by increasing care manager workload and push responsibilities to patients. Creating models that can overcome these while controlling workload inflation and patient burden is important. Through model innovation clear organizational and operational targets were created to improve medical quality, reduce workforce burden, and simplify patient experience - all without increasing cost. In short, the model maximized available medical expertise and reinvented patient journey. Tremendous amount of downstream efficiencies are created by addressing upstream sources, primarily access and use of medical expertise, medically “tightening” the delivery of care management. Future work could benefit from reassessment of tracked measures and more robust state HIE.