In this episode, Kari Curry, Medicaid Care Coordination Hub Supervisor at CHESS Health Solutions, shares how CHESS delivers high-touch, high-impact care management within a Medicaid Clinically Integrated Network (CIN).
Kari walks us through a patient journey that highlights how CHESS uses real-time data from NCHIE, comprehensive social determinants of health (SDOH) screening, and structured care planning to reduce ED utilization and improve health equity. She also covers CHESS’s success with AMH Tier 3 audit readiness and payer collaboration—proving that value-based care in the Medicaid space is not only possible, but measurable.
Transcript
00:00:00 In this episode, Kari Curry, Medicaid Care Coordination Hub Supervisor at CHESS Health Solutions, shares how CHESS delivers high-touch, high-impact care management within a Medicaid Clinically Integrated Network (CIN).
Kari walks us through a patient journey that highlights how CHESS uses real-time data, comprehensive social determinants of health screening, and structured care planning to reduce ED utilization and improve health equity. She also covers CHESS’s success with AMH Tier 3 audit readiness and payer collaboration—proving that value-based care in the Medicaid space is not only possible, but measurable.
Thomas Royal 0:24
Thank you.
Kari Curry, welcome to the move to Value podcast.
Kari Curry 0:32
Thank you.
I'm happy to be here.
Thomas Royal 0:36
So Kari, can you describe your role as a Medicaid care Coordination Hub supervisor and for someone who might not know what a care coordination hub is, how would you define it in just plain terms?
Kari Curry 0:49
Butch has their care.
Coordination represents the section of the company that includes, you know, patient calls, case management, care. Coordination is the large umbrella and then under the umbrella is the Medicare hub and the Medicaid hub. So, Hub just means team of individuals, so both the Medicare hub and the Medicaid hub make up the Care Coordination department within chess. So I supervise the Medicaid care coordination team.
Thomas Royal 1:21
That's great. So you would be the one to talk to, then about some of these topics that I'd like to learn more about and I'd like to to maybe get a better understanding through this from the journey of a patient, A made-up patient. And so let's say Maria, our Patient is a 48 year old woman recently discharged from the hospital after diabetes related complication. So she's on Medicaid. There's limited transportation.
And struggles to keep up with her appointments. Where does her journey with your team begin?
Kari Curry 1:58
Well we get notified through our documentation system when Maria is discharged from the hospital, So we will get that notification and our team will actually attempt to contact Maria within 24-48 hours of discharge to follow up with her and discuss case management services and how it could benefit her. So that's where the journey truly begins is when we get that notification.
Thomas Royal 2:50
So, Kari, so when you first hear about someone like Maria, you know, can you tell me more about what outreach and follow up look like in her case or a case such as hers?
Kari Curry 3:01
So we are integrated with the NCHIE, which is the North Carolina Health Information Exchange and receive near real time notifications of discharges within our documentation platform. So, in our platform we get what we call the ADT feed, which stands for, you know, admission discharge transfer. The ADT feed is updated in our platform daily and we strive to be on that real time notification. So, the members of the Medicaid team will outreach Maria, like I said, within 24 to 48 hours, our team aims for 24 hours for the patient who is discharged, but we allow 48 hours.
Thomas Royal 3:45
That seems pretty fast. Good work.
Kari Curry 3:48
Mm hmm.
Thomas Royal 3:48
And once that contact is made, then what happens? Like walk us through what that initial follow up might entail?
Kari Curry 3:57
Sure. So once the team has contacted Maria and discussed the reason for, you know our call and the benefits of care management, that's when the real work begins.
So Maria can agree to services or she can decline. That is her choice. In Maria's case, she does have some issues with transportation and keeping her appointments. So those are things we can help her with to ensure that she is receiving the best care despite the barriers. So once Maria agrees to the case management services and initial health risk screening is completed in the initial health risk screening, there are questions related to social determinants of health, such as issues with food, housing, utilities, transportation, interpersonal safety. This is where the care team will see that she needs help with transportation. So, the care team will provide her with transportation resources and hopes to eliminate that barrier for her.
Then the question arises to why Maria is struggling to keep her medical appointments is the lack of transportation the reason, or is there something else preventing her from attending those appointments? This is why it's important to ask those questions around social determinants of health. If Maria is agreeable to care management services, the care team will go on to complete a comprehensive health assessment, which is just more detailed and includes health conditions and other things. So along with the comprehensive health assessment, the team will complete a Med reconciliation to make sure she's compliant with her medications and a patient centered care plan. So then a follow up call will be scheduled to check in with Maria to assess her care plan progress and ensure she has transportation to her medical appointments.
Thomas Royal 5:47
Wow, that's great.
You're overseeing a team, managing people with some real struggles. It sounds like.
What? What's your philosophy or approach to that care management?
Kari Curry 5:55
Yes.
So my approach to care management is meeting the patient where they are. You may have patients that you know really need to work on their health conditions, but they have a social determinant that is causing a barrier for them to focus on their health. Start with what's important to the patient, not us.
So that's where we start.
Thomas Royal 6:25
Is that what makes care coordination work? I mean, in other words, you know what are some best practices you've seen that really move the needle for folks like Maria?
Kari Curry 6:40
Making sure you were judgment free and letting the patient know that you're there to help. There is such a focus like with patients on being healthy and maintaining their health. But if the patient has barriers preventing them from managing their health, we need to address those first and get those resolved if possible. If the patient has the tools they need, they are more willing to work on their health conditions.
Thomas Royal 7:07
Yeah, that's definitely true.
So what kind of impact have you seen and not just related to health outcomes, but on people's lives? And I mean, this can include the provider or the OR the clinical team? What are your thoughts? What do you see?
Kari Curry 7:23
With case management services, the number of emergency room visits can decrease.
Patients are aware to contact their provider office before going to the emergency room. They know when to go to the emergency room, so having appropriate care and medication compliance can decrease the cost in healthcare. There are so many benefits to care management services. We also have our patient engagement coordinator who provides resources to patients with social determinants of which has made a significant difference linking patients with the Community agencies?
Thomas Royal 8:06
Well, Kari let's talk about your favorite subject.
Let's talk about audits.
Kari Curry 8:11
OK.
Thomas Royal 8:12
I know that you're. You're a star at CHESS for your work in that area. And so, I'm relying on your expertise to just let us know what are they? Why do they matter in Medicaid and has an audit ever revealed something surprising? Or maybe an issue or a success that you didn't see coming? Tell me. Tell me all about this.
Kari Curry 8:34
I love audits.
To be at a of H Tier 3 provider, you must follow the requirement set in the Advanced Medical Home Manual, which is provided by the state. So, our documentation platform includes all the AMH requirements, and I have audits with each of our health plans to ensure that our documentation meets the requirements along with policies and procedures. I'm happy to report that CHESS has passed all their audits.
With the health plans. But I've been doing audits for a long time and once managed Medicaid went live. It was a new process, not only for health plans, but the providers as well. And I was working at another organization at the time and we had our first AMH Tier 3 audit, so didn't really know what to expect and we did really well on the audit. However, we found that the dental question within our platform was not listed as a required question. So, we had some care managers who were not asking the patient if they had been to the dentist in the past year. Well, that's a requirement.
So we were able to go in there and get that dental question in the platform to be a required question and all was well. And I think audits can also show trends that may be occurring with documentation that you may need to educate the care management staff on. So it's a great tool. At the same time. I know it can be time consuming, but it's also a great tool just to monitor the care management team.
Thomas Royal:Outstanding. So so how do you prepare for audits and what does the successful audit look like? I mean, I know you just mentioned about the dental question, but are there other common pitfalls or lessons that you've learned from past audits related to the process?
Kari Curry:Audits, like I said, can take a lot of time and it is a joint effort. However, it shows the great work that CHESS is doing. I meet with the compliance team and data and analytics team to ensure that we have all the documentation needed for the audit.
And whatever the health plan is requesting of us and to pass, all those audits has been a huge accomplishment for the CHESS team.
Thomas Royal:That's great. I know that. I know that we do discuss these a lot and you're doing great work there and we appreciate that. But let's go back to Maria, our patient that we had talked about earlier. So it's six months later, she's attending her appointments, her blood Sugar's under control, and she's joined a community Wellness group. What had to go right for all of that to happen?
Kari Curry:Removing the barriers that prevented Maria from managing her health is key.
I also think follow up calls from the care manager checking in with her and discussing her care plan is also crucial. Maria, knowing that we care and we are here to help her better manage her health, can go a long way.
Thomas Royal:Nice. Well, Carey, what would you want folks to understand about what it really takes to support someone like Maria if everything works the way it should, what does success look like for her?
Kari Curry:2 words, patience and support. Changes in a patient's health does not happen overnight. It takes time to build that rapport with them and remove those barriers with that patient. But once a patient sees a success with their health, it builds their confidence and it builds their self-management of their health.
Thomas Royal:What's one thing you wish more people understood about the day-to-day work of case management and care coordination?
Kari Curry:It’s hard work. You're going to have good days and you're going to have bad days.
You may make calls all day long and get one patient on the phone, but if you can make a difference with that one patient, it's all worth it.
Thomas Royal:And Kari, finally, what's something you've seen recently that reminded you why your work matters?
Kari Curry:While I was working with a patient not too long ago who wanted to lose weight and she wanted to just be more active in general and I mailed her information on food choices and the importance of exercise, and we had set a goal and started a care plan. So, every month we would discuss her eating habits and her exercise routine.
And after a couple months, she called me after she had gone to her doctor's appointment, and she was so excited. She had lost 5 lbs. And so, we of course cheered her success, and she was excited about losing those 5 lbs. but she was more excited in the fact that she could take her kids to the park and play for longer periods of time without just getting exhausted. So in this job, you're gonna have a lot of patience that don't want to work with you, or you may lose contact with them or they decide they just don't wanna work with you anymore. But when you have a patient that sets a goal with you and they are able to meet that goal and make differences in their life or a healthier lifestyle, it makes it all worth it.
Thomas Royal:Wow, that's awesome.
That sounds like a really rewarding thing to have.
Kari Curry:Absolutely.
Thomas Royal:Well, Kari Curry, thank you for joining us today on the Move to Value podcast.
Kari Curry:Of course. Thank you