title: Barriers and Facilitators to Coordinating Care With High-Risk, High-Cost Disabled Medicaid Beneficiaries: Perspectives of Frontline Staff and Participating Clients.
abstract: This evaluation was designed to examine the perspectives of 15 frontline staff who implemented a managed care program and 154 high-risk, high-cost disabled Medicaid clients who were participants in the program. Results indicated that positive relationships between staff and clients played a key role in facilitating program implementation. Challenges included finding ways to provide a wide breadth of services including food, shelter, and transportation; handling difficulties following from staff turnover; and creating transitions of care for clients to community health clinics. Staff identified training in motivational interviewing and having both nurse care managers and social workers collaboratively deliver the intervention as among the most powerful components of the program. Staff and clients expressed high levels of satisfaction with the program, and clients believed they were experiencing positive impacts of the program. Lessons learned from this study may inform the design of services as the Affordable Care Act continues to unfold.
authors.affiliation: School of Social Work, University of Washington, Seattle, Washington, USA.
authors.forename: Meg
authors.initials: M
authors.lastname: Cristofalo
authors.forename: Antoinette
authors.initials: A
authors.lastname: Krupski
authors.forename: Imara I
authors.initials: II
authors.lastname: West
authors.forename: David C
authors.initials: DC
authors.lastname: Atkins
authors.forename: Jutta M
authors.initials: JM
authors.lastname: Joesch
authors.forename: Lindsay
authors.initials: L
authors.lastname: Jenkins
authors.forename: Beverly
authors.initials: B
authors.lastname: Court
authors.forename: Janice
authors.initials: J
authors.lastname: Bell
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
mesh_terms: D003150:Community Health Workers; D006233:Persons with Disabilities; D017144:Focus Groups; D006285:Health Planning; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid; D058991:Patient Protection and Affordable Care Act; D016730:Program Development; D015397:Program Evaluation; D014481:United States