Stakeholder report 2021
Father embraces pysically challenged son

Complex Care

Compassionate Solutions for Complex Challenges

CareSource has long focused on delivering holistic approaches to meet the health and wellness needs of our members. Certain populations, including individuals with intellectual and developmental disabilities, children in foster care, individuals with serious mental illness, veterans and aging adults with special needs, have complex medical, behavioral and social needs that warrant a distinct and fresh approach to managed care.

The CareSource person-first approach for complex populations promotes self-determination, inclusion and independence. At the foundation of CareSource’s Complex Managed Care is a care coordination model that puts the member in the driver seat of the planning process. Facilitated by a CareSource care coordinator, the member and his or her chosen support team comprised of caregivers, health care providers, community-based organizations and social services providers, among others, guide the development of a person-centered plan that identifies the member’s preferences, strengths and goals. Together, they then outline the services and supports necessary to assist the member in realizing those goals. Our care coordinator then walks alongside the member and their caregivers to ensure they have every opportunity to achieve those goals and realize an improved quality of life.

Partnerships with Purpose

CareSource’s Complex Managed Care Model embeds a systems of care approach, building partnerships, both nationally and locally, with those community organizations and stakeholders who support the same individuals with complex health and social needs. CareSource engages community stakeholders to create access to integrated and inclusive community services and supports for our members.  This engagement promotes cultural competency within the system of care that impacts and supports complex populations, like social services agencies, school systems, criminal justice systems and community-based organizations.

For CareSource, quality improvement for complex populations means more than HEDIS measures and CAHPS scores. CareSource’s Complex Managed Care approach incorporates quality measures and value based reimbursement strategies that aim to improve quality of life for our members, as they define it.

Intellectual and Developmental Disabilities

Family and unpaid caregivers play a critical role in meeting the health and wellness needs of individuals with intellectual and developmental disabilities. Nearly half (48%) of caregivers report they are very stressed. Caregivers provide nearly 60 hours per week of uncompensated care for their loved one with I/DD.

People with I/DD live with a family caregiver.

Serious Mental Illness/Severe Emotional Disturbance

Individuals who experience symptoms associated with serious mental illness are at the greatest risk for criminal justice involvement, homelessness, hospitalization and/or involuntary treatment.

Individuals with SMI/SED are four times more likely to experience drug or alcohol dependence.

Child Welfare

On average, children in the child welfare system have experienced four or more adverse events before the age of 18, and 80% of children in foster care have significant behavioral health needs. Only 60% of children in foster care are living with kinship caregivers.

Children in foster care are six times more likely to have significant mental health issues.

Aged, Blind and Disabled

Aging individuals or individuals with disabilities are twice as likely to need assistance with activities of daily living. Sixty-seven percent of expenditures on long-term services and supports for older adults and individuals with physical disabilities were for institutional care, predominantly in nursing facilities.

Adults aged 50 and older would prefer to live in their own communities for as long as possible.

CareSource understands that each individual’s needs are unique, but that we all strive for independence and the ability to direct our own care. One-sized-fits-all solutions don’t fit individuals. That’s why other insurers will shy away from this population. That’s why CareSource embraces it. We passionately believe that everyone deserves an equal opportunity to live a healthy life.