Right Place, Right Setting, Right Time: Collaboration Between Managed Care and Acute Care

CountyCare is the largest managed Medicaid plan in Cook County, IL (which includes the metropolitan Chicago area) with over 800,000 members in 2019. County Care is directly affiliated with Cook County Health Systems, anchored by Stroger Medical Center, formerly Cook County Hospital. In late 2018, a problem was identified that many members were utilizing out of network services/facilities to receive their care. This led to fragmented care, tremendous cost to the plan, and the inability to enroll patients in complex case management as needed.

To address this issue for all stakeholders, a process was needed to identify patients prior to admission to out of network facilities and re-route them to the appropriate in-network care providers. The Stroger Medical Center Emergency Department Case Management Program and CountyCare Complex Case Management Program came together to problem solve and create a process to transfer patients who were being admitted for care from out of network facility
Emergency Departments to Stroger Medical Center’s Emergency Department; creating efficiency in the system that was unheard of previously.

The program involved the collaboration of acute care and managed care, several community partners and the patients themselves to identify and facilitate appropriate transitions, increased continuity of care and linkage to complex case management for medical and social service needs.

By the end of this session, the learner will be able to:

  • Explore the current state of Emergency Department Case Management
  • Discuss the importance of “right place, right setting, right time” from managed care and acute care perspectives
  • Review ED to ED transfer program through project conception, initiation, implementation and outcomes

 


Jeff Crofoot 2020 case managers cruise speakerJeffrey Crofoot MSN RN CMCN ACM-RN is the Manager of Case Management Services for Cook County Health Systems; Emergency Department & Transfer Center Programs in Chicago, IL.

He has held roles in both acute care and managed care case management leadership throughout his 30+ year nursing career. He has focused on readmissions, creation and refinement of programs to improve outcomes, and departmental reorganization/restructure to improve outcomes and increase staff satisfaction.

His clinical specialties include Med/Surg, ICU and Home Health.  He received his diploma in Nursing from Evangelical School of Nursing in Oak Lawn, IL; BSN at Jacksonville University in Jacksonville, FL, MSN from Grand Canyon University in Phoenix, AZ. He is active with CMSA Chicago, currently serving as Secretary.