Common use of Care Management Model Characteristics Clause in Contracts

Care Management Model Characteristics. The HMO will have flexibility in developing its own care model(s) but it must have the following characteristics: a. Effective Member Outreach and Engagement HMOs must develop effective outreach strategies to connect with and engage SSI members using a member-centric, culturally competent, collaborative approach to care. The HMO must encourage member self-determination and self-care. b. A Coordinated, Team-based, Patient-centered Approach to Care The HMO’s care management model must take into consideration the importance of shared decision-making between the care management team and members; the need for scheduling flexibility; and the need for team-based, care coordination services. c. Social Determinants Approach to Care Addressing member social determinants is a critical consideration for SSI members. While the HMO is not required to provide “wrap around” social services, the HMO must establish partnerships and maintain effective working relationships with key social service and community-based agencies to ensure the social determinants of health (e.g., housing instability, low health literacy, chronic stress, traumatic life events, and other social factors) are identified and addressed.