Care Management & Care Coordination

Care management (CM) is a team-based, person-centered approach “designed to assist patients and their support systems in managing medical conditions more effectively.”1 Care management includes a set of services and activities that help people with chronic or complex conditions manage their health, with an overarching goal of improving and maintaining health.

Care management includes those care coordination activities needed to help manage chronic illness. Unlike case management, which tends to be focused on managing disease, care management is organized around the idea that appropriate interventions for individuals will reduce health risks and decrease the cost of care. 

Care management and coordination are key components of integrated, whole person care for individuals enrolled in both Medicare and Medicaid. Dually eligible beneficiaries often have multiple health care, behavioral health, long-term services and supports, and social service needs. Many face adverse social risk factors that may affect health status – social determinants of health (SDOH) – such as housing insecurity and homelessness, food insecurity, inadequate access to transportation, poverty, and low health literacy. This diversity and combination of needs underscore the importance of health plan care coordination for dually eligible beneficiaries that effectively assesses their range of needs; incorporates those needs and individual preferences and goals in person-centered care plans; and coordinates and shares information across all needed medical and non-medical providers and supports, including family and other caregivers.2

Resources for Integrated Care features practical resources for providers and plans providing care management and coordination to dually eligible beneficiaries. These products and webinars highlight promising practices, lessons learned, and stories from the field to support the delivery of integrated and coordinated care tailored to the needs of this population. Developed with input from a range of providers, plans, and other subject matter experts, these resources focus on the following topics:

  • Care Transitions

  • Community Health Workers

  • Community Supports & Resources

  • Interdisciplinary Care Team (IDT)

  • Navigation Services

  • Peer Supports

1 Centers for healthcare strategies. Care management definition and framework (2007).

2 Barth, S., Silow-Carroll, S., Reagan, Russell, M., Simmons, T. (2019) Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches. Report to the Medicaid and CHIP Payment and Access Commission.