Competency Area #5: Provide coordinated care and/or complex care management that is highly responsive to MassHealth member needs and preferences
The key elements that comprise Competency Area #5 are outlined below. These can be used as touchpoints in determining whether your TA project helps advance your ACO or CP in this competency.
Models of care: ACOs and CPs develop, implement, evaluate, and refine models for providing coordinated care, as well as targeted and intensive complex care management, for the unique population(s) of MassHealth members they serve in order to ensure that care and services are easily accessible, appropriate, and cost effective for every MassHealth member enrolled in the ACO or CP.
Member responsiveness: ACOs and CPs draw upon member data and qualitative insights into member characteristics, preferences, and needs in order to ensure that all models for care coordination and complex care management are designed and implemented in a manner that is highly responsive to the unique population(s) of MassHealth members the ACO or CP serves.
Data exchange and communication: ACOs and CPs develop and maintain infrastructures and workflows that facilitate communication and exchange of member data across all entities involved in care coordination and complex care management in order to facilitate the ease and effectiveness of such activities.
Training and resources: ACOs and CPs provide and facilitate access to training and resources on care coordination and complex care management for all clinical and non-clinical members of care teams in order to support a strong and stable workforce and ensure that all care team members can engage capably and confidently in new models of care.
ACO/CP Integration: ACOs and CPs develop, implement, evaluate, and refine shared models for providing coordinated care and complex care management across ACO-CP partnerships in order to ensure that MassHealth members with the most complex behavioral health, long-term services and support, and health-related social needs benefit from comprehensive and seamless systems of care.