A Longitudinal, Relationship-Based Model for Managing Complex Chronic Disease in the Medicaid Population

Area of Science:

• Health Services Research
• Clinical Case Management
• Healthcare Policy

Background:

• Complex and chronic diseases pose challenges for healthcare systems aiming to improve value.
• Social determinants of health disproportionately affect vulnerable populations, hindering engagement with healthcare.
• Transactional interventions have proven ineffective for long-term improvement in outcomes or cost reduction for these individuals.

Purpose of the Study:

• To identify core barriers preventing transactional interventions from effectively addressing complex health and social problems.
• To propose a shift from transactional to relational case management frameworks.
• To outline key principles for a relational clinical case management model.

Main Methods:

• Identification of three core barriers: trust, self-efficacy, and complexity.
• Development of a relational framework for case management.
• Implementation of five key principles: continuity of care, leveraging relationships, titrated support, flexibility, and patient resourcefulness.

Main Results:

• Relational case management addresses barriers of trust, self-efficacy, and complexity.
• A long-term, relationship-based approach enhances client engagement and overcomes barriers.
• The proposed model demonstrates practical application within a healthcare system.

Conclusions:

• Evolving from transactional to relational case management is crucial for improving care for complex and chronic conditions.
• The five key principles provide a structured yet flexible approach to clinical case management.
• This relational model offers a sustainable strategy for enhancing patient outcomes and system value.