Integrated Medical Management Model (IM3) and Early Case Finding

First and foremost, care management programs are about members – anticipating and meeting each individual’s healthcare needs efficiently and in a respectful, caring manner. Fundamental to this approach is a care coordination system that integrates all physical, behavioral health, and community support services for health plan members.   The program incorporates multiple facets of our overall case management including Early Case Finding, Continuous Case Finding, Pilot Project 505 which is a best practice in Maryland for recognizing and prioritizing our high risk cases, CarePlus Case Management System, and our NCQA accredited Disease Management programs.

The Integrated Medical Management Model provides a coordinated comprehensive approach to ensure members receive services at the appropriate level of care through individualized, innovative programs and coordination with community services.

The program is designed to ensure members receive appropriate help at the right time.

For some, that assistance may be as simple as scheduling an appointment with the member’s PCP. For others, it will mean coordinated, comprehensive case management across multiple care systems, such as prenatal care, behavioral health and substance abuse services, and wraparound support services. 

This next generation care management model integrates physical, behavioral, and social factors into the coordination of members’ care. The process involves a thorough assessment of member health status immediately upon enrollment, accurate stratification into appropriate levels of care, and effective management and monitoring of that care. Our innovative model is uniquely adapted to each of our member populations. Based on AMERIGROUP’s experience, we recognize the unique needs of the varied Medicaid populations, including, but not limited to: mothers and infants; the fragile elderly; persons with disabilities, member with co-occurring or comorbid conditions; and persons with chronic and complex issues. The IM3 process manages them appropriately – ranging from health education to comprehensive case management.

As one of the most experienced managed care organizations (MCO) serving TANF, CHIP, SSI, LTC, and SNP populations, we bring a significant advantage to our state partners through our fully Integrated Medical Management Model.

With more than 11 years’ experience nationally, AMERIGROUP offers proven, effective managed care processes focused on the Medicaid population and their unique needs. Additionally, Our IM3 program assists a member in making sound healthcare decisions. We identify the physical and behavioral healthcare needs of our members through our health screening and assessment process. Those members with the greatest need for healthcare services are assigned to our case managers who work directly with the members to get the healthcare services they need. As the only MCO fully integrating physical health, behavioral health/substance abuse, and social factors through our IM3 model, we are more cognizant of and distinctively able to offer a broad range of care management services to our members. 

The cornerstone of IM3 is our Early Case FindingTM (ECF) health assessment process proactively identifying and stratifying members into appropriate tiers based on member needs.  This process includes the use of a customized software tool that allows AMERIGROUP to adapt assessment questions to address the specific needs of the State’s Medicaid population. The initial health assessment determines a member’s needs across three domains – physical, behavioral, and social – and assigns an overall risk score. Based on the member’s score (and a continuous reevaluation of the member’s needs) AMERIGROUP provides access to the appropriate level care and additional support services the member needs. 

We cannot stress enough the importance of the medical home approach to providing high-quality and cost-effective healthcare services for children and adults. AMERIGROUP knows the quality of member care is greatly improved when members proactively choose their own PCP, one with whom they have an established relationship, or with whom they feel comfortable developing a relationship.

Our IM3 program has been designed to synthesize a medical home approach with appropriate care coordination services that is population focused and specific to individual needs.  This is the heart of what we do every day for our members.