Implementing Care Manager Core Competencies in the Context of Caring for an Indigent Patient Population

Forty-five million people in the U.S. are uninsured . One of the critical problems encountered by the uninsured is the lack of continuity of care. The Marshfield Clinic Community Health Access (CHA) Program, a multi-specialty clinic system, provides preventive health services and disease management to the indigent population in Wisconsin. The program aims to assist patients in navigating the health care system to help them understand the importance of preventive health care and to manage their chronic conditions using health coaching through consistent contact with nurse care managers.

Over 2,000 patients have been enrolled in this program since September 2005. Of these, 39% are men, the average age is 41 years, and over one -third have been contacted by a care manager more than once.

To better communicate and work with this uninsured and underinsured population, CHA care managers have had to develop multiple skills over time. CHA CM requires diverse skills that include telephonic interviewing, comprehensive risk assessment and re-asssessment, care plan development, problem-solving, motivational interviewing, and introducing available community resources. Working with Pfizer Health Solutions Inc, Marshfield Clinic implemented an innovative Care Manager Competency (CMC) training program that sought to help assess the quality of CM services and suggest areas where further development may help care managers better serve this population. Five core competencies were identified: (1) professionalism and teamwork, (2) clinical competency, (3) problem solving skills, (4) communication skills, and (5) technical skills. The framework of this approach was built upon a set of flexible tools that were adapted for the CHA program to identify, track, and coach or strengthen key competencies. In the implementation process, the CHA program manager collaborated with the care manager using CMC tools to conduct a pre-assessment for baseline competency, monitor calls, audit charts, set educational plans, and follow up with post-assessment activities for individual care manager development.

The initial phase of the CMC Program has been beneficial to CHA care managers to quantitatively assess and encourage skill development. Final impact of the CMC program on data integrity, care manager satisfaction as well as clinical, preventive and utilization outcomes, will be presented.