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Intensive Case Management/Resource Coordination Services Help People on the Road to Recovery

Intensive Case Management/Resource Coordination (ICM/RC) services are available to help eligible members on their road to recovery. ICM/RC services may also be referred to as Blended Case Management or Service Coordination services.

ICM/RCs provide the following services:

• Create a Strengths Based Service Plan
• Help consumers develop and maintain ties to the community
• Participate in the Treatment Team to make sure consumers get the care they need
• Crisis intervention, including diversion from the most restrictive types of care (inpatient, residential, etc.) when appropriate
• Make sure the consumer and his/her family can choose the service provider that best fits their needs
• Work with the consumer during his/her recovery and provide education and training
• Use the recovery principles throughout the treatment process, especially encouraging consumer self-management of the illness

These are Medical Assistance-funded activities for people with psychiatric disabilities which have caused significant levels of functional impairment.

Community Care, along with consumers, families, providers, the Allegheny County Department of Human Services Office of Behavioral Health, Allegheny HealthChoices, Inc. (AHCI), and other behavioral health stakeholders have developed performance standards for ICM/RC services. By evaluating that providers meet or exceed the performance standards, Community Care ensures that members are receiving the highest quality of care.

Community Care monitors ICM/RC service provider contact:

• During an inpatient stay
• Within three days after discharge from inpatient
• Within 30 days after inpatient discharge

For members receiving ICM/RC services, Community Care’s guidelines specify that Intensive Case Managers and Resource Coordinators:

• Coordinate care upon admission
• Work with the member and hospital staff to develop an effective discharge plan, which should outline follow-up care, including an outpatient visit within seven days of discharge
• Communicate with the inpatient team within 24 hours to begin discharge planning
• Provide support in times of crisis
• Assess for appropriate interventions and diversion from inpatient if indicated
• Coordinate care with the member’s providers, as well as his or her family or significant others, and together create a recovery plan.

ICM/RC service providers are expected to have contact with the member within three days following discharge. This contact is an opportunity for the ICM/RC service provider to:

• Check in with the member
• Support him or her in keeping follow-up appointments

Together, the provider and member should identify and address the things that might make it difficult for the member to keep follow-up appointments or lead to a readmission. Hospitalization can be stressful; members may need extra ICM/RC support during and after a hospital stay.

Ensuring that members receive high quality services is an extension of Community’s mission—to improve the health and well-being of the community through the delivery of effective and accessible behavioral health services. If you have questions or would like more information, please call your region’s Community Care office and ask to speak to a Customer Service Representative.

The following graphs show the rates of Allegheny County ICM/RC service provider contact during an inpatient stay and within three days following inpatient discharge, and the number of contacts within thirty days of inpatient discharge. For each graph, the network average is shown in orange. Providers who scored 100% are in bright yellow. Providers who were above the network average are in dark blue. Providers below the network average are in light blue. Community Care’s expectation (the Benchmark) is shown on each graph by the gold line.

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