Care Management vs Case Management in Virginia

Last Updated on October 14, 2023

Commonwealth Coordinated Care Pus or CCC Plus  is a statewide Medicaid managed care program  implemented in August 2017. Under this program, each person who meets the criteria will be assigned a Care Coordinator.  These care coordinators appear to have a similar role as current case managers who serve these individuals in public agencies like community service boards. This situation has many case managers concerned that they will be eventually replaced by these private companies.

There is good reason to be concerned about these recent changes. For many public agencies, the revenue generated through case management billing not only funds case manager salaries but they also fund other programs within the agency that don’t bring in enough revenue. Here are the key areas of concern that have public case managers a little nervous.

Competition- Care coordinators seem to have the same basic functions  as case managers. Some have even started to sit in on  annual meetings with case managers.  Case managers still coordinate the majority of the support services at this time. However, this could change in the future as case managers are starting to transition to these private  Managed Care Organizations. This could eventually threaten job security in public agencies. 

Loss of Good Employees- Case managers have already started to transition into positions as Care Coordinators with private managed care companies. Many of these case managers have years of experience in the areas of mental health and intellectual disability. This experience is valuable due to the constant changes in regulations. Intellectual disability services in particular seem to get more complicated every year.  The loss of talent and experience can set agencies back due to constant hiring and retraining of new staff. 

Do People Need Two Case Managers? – Another concern is a potential duplication of services. Service roles are not clearly defined which leads to both care coordinators and case managers essentially providing overlapping services. The concern is that Medicaid will eventually choose one over the other to coordinate services.  This is why some case managers are making the move and taking jobs with private companies. They feel that like  other states, mental health and intellectual disability services will eventually move to mostly private providers.  

How can public agencies compete with private Managed Care Organizations?
The introduction of CCC Plus will change the way public agencies provide services. Public agencies are not typically considered a business because they often provide services free of charge to the consumer. However, public agencies take in revenue from Medicaid and local tax payers in order to operate to pay employees. Public agencies will have to adjust their operations and adopt a more “business-like” approach to compete with private companies.  Here are a few ideas I feel can help even the playing field with private companies.

Research the Competition – Find out what the competition is doing to and understand why your employees are leaving. See what the competition is doing and try to replicate and improve their techniques. Restaurants, department stores, and other businesses do it all the time. It’s time for public agencies to learn how to compete.

Embrace Teleworking- The option to  telework  is one of the key reasons case managers are choosing to work for private companies. Teleworking has also been shown in some cases to
improve productivity  and morale. The "old-school" way of clocking in and out is pretty much obsolete in the area of case management. So much of the job can be conducted at home or off site such as phone calls, notes, and reports. The old way of thinking is that “if we don’t see you then you’re not working”. The new way of thinking embraces the flexibility and convenience that teleworking can provide.

Rewards for Performance- I think this can be a huge morale booster and can improve performance. Private companies do this all the time and I believe that public agencies can benefit from providing incentives for performance. When I mean incentives I’m not talking about movie tickets or water bottles. I’m taking about financial incentives in the form of bonuses. Here are a few things that can be incentivized:

*Timely Paperwork

*Taking on Additional Cases

*Taking Difficult Cases

*Exceptional Performance

Embracing practices traditionally used by private companies can help public agencies compete. Public agencies have a current advantage because they have been the number one choice for so many years and have case managers that are more experienced with mental health and intellectual disabilities at this time. This is the time to develop strategies to compete because private case management is here to stay.

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Martin Gardner
Thanks for visiting Case Management Basics! Martin Gardner is the founder of and Case Management Basics, LLC. Gardner is a mental health professional with over 20 years of experience in the human services field.

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