This MCO decided to participate in order to develop better care coordination for its members and to integrate across the acute and long-term care continuum. UCare uses a primary care clinic-based system and contracts with other systems, such as EverCare, for care coordination and physician services for enrollees living in nursing facilities, counties for HCBS, and specialty care providers. When asked about the incentive for care systems to meet MSHO's goals, particularly to use the lowest cost intervention appropriate to the need, Mr. Walsh replied that UCare holds quarterly meetings with each of the care systems to discuss such issues as part of the oversight function. Upon enrollment, a member chooses a primary care clinic that is part of a care system. A care coordinator from that care system is then assigned to that member.
Teams meet on a situation basis.
The success of the care team has thus far depended on the persistence of the care coordinator in reaching out to providers, especially physicians. Care coordinators do not need prior authorizations for services from UCare but do need physician approval. Caseload varies from 75 to 150 members. Serving as the primary contact for members and their families. This care coordination has resulted in the improved ability to care for the member in the most appropriate setting .