UM SSW The Institute  
 

Care Management Entities

Contact Info:

Denise Sulzbach, Director of Policy & Strategic Development, dsulzbach@ssw.umaryland.edu or 410-706-3364

Deborah Harburger, Director of Fiscal Strategy, dharburger@ssw.umaryland.edu or 410-706-1868

Youth with complex needs and their families typically are involved with multiple providers and systems, or are at very high risk for such involvement. No single provider or system can respond comprehensively to the constellation of needs of these youth and families. As a consequence, youth and families end up with multiple plans of care and multiple care coordinators, a situation that is confusing and inefficient for all concerned. Over the past decade, new technologies have emerged in children's services that create one "locus of accountability" for youth and families involved in multiple systems. These technologies, which support the organization, management, delivery and financing of services and supports across multiple providers and systems, are implemented through a Care Management Entity (CME) structure.

The goals and functions of a CME align with those of health homes as set forth in the Affordable Care Act (Public Law 111-148, "Patient Protection and Affordable Care Act" (Sec. 2703)). The function of the CME is to design and implement plans of care to achieve defined outcomes for youth and their families that make sense both to the youth and family and to the systems in which the youth is involved.

A CME is responsible for developing and implementing comprehensive individualized plans of care (POC) with each participating youth and his or her family. These plans are driven by the strengths and needs of the individual youth and family rather than by the boundaries of discrete programs, agencies or funding systems. The High Fidelity Wraparound model is used to implement the care coordination process provided by the CME, with fidelity to the High Fidelity Wraparound principles and its practice model evaluated by a neutral party. In addition to implementing a High Fidelity Wraparound approach to ensure the development and oversight of an individualized plan of care that governs all providers and systems involved with the youth and his/her family, the CME also provides the youth and family with a dedicated care coordinator (i.e. a full-time care coordinator with a small caseload).

The CME provides intensive care coordination using a High Fidelity Wraparound service delivery model, manages a comprehensive provider network of both traditional and non-traditional/natural supports, and utilizes a management information system that enables data-informed decision-making. The care coordinator and the CME assume responsibility for managing the POC and facilitating the child and family team meetings.

Resources:

  • Center for Health Care Strategies (2011) Care management entities: A primer. Washington, DC: Center for Health Care Strategies. Available at: http://www.chcs.org/usr_doc/CHIPRACMEPrimer.pdf
  • Center for Health Care Strategies (2012) Using care management entities for behavioral health home providers: Sample language for state plan amendment development. Washington, DC: Center for Health Care Strategies. Available at: http://www.chcs.org/usr_doc/CMEs_as_Behavioral_Health_Homes_-_SPA_Development.pdf
  • The Maryland Child and Adolescent Innovations Institute and Mental Health Institute. University of Maryland (2008). The Maryland care management model: Care coordination using high-fidelity wraparound to support the strengths and needs of youth with complex needs and their families. Baltimore, MD.
  • Summary of Key Considerations in the Use of the Health Home & 1915(i) State Plan Amendments for Children & Youth with Intensive Behavioral Health Needs
  • Bruns, E.J., Walker, J.S., Zabel, M., Matarese, M., Estep, E., Harburger, D., & Mosby, M. (2009). Intervening effectively in the lives of youth with complex behavioral health challenges and their families: The role of the wraparound process. American Journal of Community Psychology, 46, 314-331. doi: 10.1007/s10464-010-9346-5
    • Abstract: Wraparound is an individualized, team-based service planning and care coordination process intended to improve outcomes for youth with complex behavioral health challenges and their families. In recent years, several factors have led High Fidelity Wraparound to become an increasingly visible component of service systems for youth, including its alignment with the youth and family movements, clear role within the systems of care and public health frameworks, and expansion of the research base. In this paper, we provide a review of the place of the wraparound process in behavioral health, including a discussion of the opportunities it presents to the field, needs for further development and research, and recommendations for federal actions that have the potential to improve the model's positive contribution to child and family well-being.