Care Management and the Affordable Care Act

One of the most intriguing provisions of the Affordable Care Act, is the creation of patient centered medial homes and Accountable Care Organizations (ACOs). ACOs, often referred to as medical home neighborhoods or villages, rely on Patient Centered Health Care Homes (PCHCH) and a circle of providers to deliver quality care within the primary care relationship and beyond. In this model, the ACO contracts to receive reimbursements from Medicare, Medicaid, and/or private payers and makes payments to the Care Home physicians and other ACO providers.

The thinking behind this new idea is that coordinated, patient centered care will not only produce better outcomes for patients, but will contain cost by avoiding duplication of effort and procedures that are unnecessary based on the “big picture” for that patient.

Patients and their families who have retained Case Managers already recognize the benefit of this model. Case Managers work with patients and their families to focus on wellness, prevention, and efficient care for entire populations of patients. In their role as the central coordinator for patients and their families, case managers simultaneously consider clinical, financial, and patient advocacy functions as they balance competing interests. While case management has historically been reserved for complex cases, the trend toward ACO’s makes it right for everyone.

Life Care Planning Law Firms have long recognized the value of Case Management by incorporating Elder Care Coordinators into the practice of Elder Law. These Care Coordinators are professionally trained to oversee the Care Managers, as well as care providers, and assure that they are further integrated into a holistic plan that also considers the patients financial and legal situation. See www.lcplfa.org for more information.

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