This year’s theme for National Case Management Week is keeping the person at the heart of collaborative care. Celebrated the week of October 8-14, we’re recognizing the crucial role of case managers on healthcare teams. These individuals have the important responsibility navigating the complex healthcare system to facilitate care coordination and connecting members to the resources they need.

We’re spotlighting Valerie Lees, senior care manager for Magellan Behavioral Health of Pennsylvania. Lees is responsible for reviewing and approving mental health and substance use disorder services for members across five Pennsylvania counties and assisting providers with patient discharge, planning, and care coordination to provide the member with direct assistance.

Continue reading to learn more about what Lees does as a case manager and what National Case Management Week means to her:

What exciting projects are you currently working on as a case manager?

I’m excited to be part of a few very active and ongoing projects. One of them focuses on increasing care coordination, especially for those members in any kind of 24-hour level of care. Care coordination involves meeting with our 24-hour level of care treatment providers and in these meetings, we brainstorm, discuss, and collaborate on ways to assist the member to increase their community tenure. We look at many different factors, from the members’ clinical needs to their social needs.

I’m also working with a co-worker on presenting a trauma training that will be presented to all Magellan staff. This is an area of interest of mine and it’s great to be part of educating and learning about topics like trauma informed care and best practices for members who have experienced trauma.

Lastly, myself and other members of the 24-hour level of care team at Magellan will take part in a volunteer project at a local shelter in Lehigh Valley where we will be preparing and serving lunch for the shelter’s residents. It’s a wonderful opportunity to connect with the community.

Why is Magellan Behavioral Health of Pennsylvania the best place to do these projects?

Magellan has a large skilled and diverse staff, working with so many talented people does create the best environment to work on projects. Many of our members have complex needs that go beyond the clinical realm and it’s nice to have so many talented people come together to find new ways to help improve the quality of care our members receive and ultimately the quality of their lives.

What are your thoughts on the culture here at Magellan Behavioral Health of Pennsylvania? How has that culture had an impact on your projects?

I think the culture is truly one of connection and collaboration. I have always had the sense that everybody that works here, no matter what they do in what department, has a shared goal to improve the care and quality of our members lives. The Magellan managers are always encouraging my colleagues and I to think outside the box. I feel very supported in that way. It’s really a culture where projects can thrive because of this out-of-the-box thinking where people’s voices are heard.

October 8-14 is National Case Management Week. How did you first get involved with case management and what are some of the challenges and rewards of working in this field?

I started in case management when I worked in inpatient psychiatric hospitals. I met with case managers there who were discharge planning for patients and started meeting with case managers from different insurance companies as well. I started collaborating with them quite a bit, that’s when I really got a taste of case management. Ultimately, the goal is always to collaborate and figure out different ways to help people. I think that case management goes beyond just supporting people with their mental health or substance use disorder challenges, it’s all encompassing. A case manager looks at the whole person. So not only are we looking at what we can do treatment wise for any mental health challenges or substance use disorder challenges that a member may have, but we’re also looking at their social determinants of health issues as well.

What does it mean to be a case manager? Is there anything you’d like to highlight about this field for National Case Management Week?

To me it means that I get to collaborate and help people, which is what I’ve always wanted to be able to do. Being able to collaborate with people in other departments at Magellan allows me to learn new ways to assist our members. I also really enjoy collaborating with other case managers, social workers, nurses, etc. outside of Magellan. The entire process is very rewarding and fulfilling for me.

The theme for National Case Management Week this year has to do with keeping the client in the center of what we do and that’s something that I completely agree with. I see that happening every day here at Magellan and it’s an honor to be a part of it.

As healthcare evolves, reimbursement models continue to shift from volume to value. That means more providers are taking risk and moving into value-based reimbursement models. One such model is the Accountable Care Organization (ACOs) in which the provider has accountability for achieving quality improvements and spending reductions.

ACOs are not the only model. In today’s market, providers often form and/or contract with entities such as Managed Services Organizations (MSOs), Clinically Integrated Networks (CINs), or Independent Physician Associations (IPAs). For providers, the benefit of these organizations is clear: they supply the infrastructure and tools to be successful in meeting quality and cost targets required for their value based contracts. The result is better care for patients (especially the chronically ill), reduced waste and inefficiencies and financial incentives that are structured on quality benchmarks. ACOs, MSOs, CINs, and IPAs all incentivize primary care providers (PCPs) to improve the health of their entire patient population.

There are hundreds of these organizations across Medicare, Medicaid, and Commercial lines of business and many are executing value contracts and already realizing shared savings for primary care.  As they come together, the providers develop increased access to enhanced technology and expanded patient reach.  As these organizations mature, they are also beginning to engage specialists in value initiatives.

Magellan’s view of value is Specialty Care

To support value in specialty care, Magellan has developed a provider solution that is centered on behavioral health and physical health integration. It is designed specifically for provider organizations to successfully manage population health and take on risk under value based reimbursement through clinical, operational, and digital capabilities. Program components support the entire continuum of care and include:

• Screen & Engage: More accurate diagnosis through tools that are embedded into the primary care practice workflow
• High Performance Networks: Increased access to providers with improved quality and efficiency scores who embrace the vision of population health and support value based payment
• Case Management: Collaborative approach with warm hand-offs between the primary care office to Magellan to drive better outcomes
• Collaborative Care Model: Team-based integrated behavioral healthcare driven by Magellan expertise and digital screening capabilities to track patient progress and treat to target
• Authorization Support, Concurrent Review  & Transitions of Care: Discharge planning and case shaping to support patients transitioning from an inpatient facility to their home
• Telehealth: Increased access to care through a network of telehealth providers and text therapy providers
• Other Digital Solutions: Digital Cognitive Behavioral Therapy (D-CBT) for patients that is integrated with Magellan’s Smart Screener

In addition to the core solution set, Magellan has a comprehensive suite of behavioral health, specialty, and pharmacy products that can be customized for provider organizations. Magellan also supports providers in developing accountable care organizations for complex specialty care such as cardiac conditions. This approach supports and incentivizes cardiologists to proactively managing patients to improve quality and reduce costs. Magellan recently entered into its first specialty ACO relationship and will continue to develop and launch these types of relationships.