Kern Health Systems (KHS) offers the Enhanced Care Management (ECM) benefit for eligible Kern Family Health Care (KFHC) Members. These services help coordinate the Member’s physical, behavioral, developmental, oral health, long term services and supports (LTSS), and services that address social determinants of health.
There is no cost to the member for ECM services.
If you would like more information or to find out if the KFHC Member qualifies please call us at 1.800.391.2000. You or the eligible KHFC Member may also be contacted by KHS or our contracted ECM providers to see if they are interested in enrolling into an ECM Program.
Who is eligible for ECM?
KFHC Members may qualify for ECM if they are within one (1) or more of the following Populations of Focus. Members receiving hospice services and/or members receiving any type of care under a 1915(c) waiver do not qualify.
Adults experiencing homelessness such as members who are:
- Lacking adequate nighttime residence
- Living in a shelter
- Imminently losing housing in next 30 days
- Victims fleeing domestic violence
Adults who have been admitted to the hospital three (3) or more times in the past six (6) months or have visited the Emergency Department five (5) or more times in the past six (6) months
Adults experiencing a serious mental illness or suffering from a substance use disorder.
- Members who qualify are those receiving services through County Specialty Mental Health or Drug Medi-Cal and meets one (1) or more of the following:
- Uses the emergency department, urgent care, or inpatient hospital as sole source of care
- Is at high risk of hospital or skilled nursing facility admission, overdose, and/or suicide
- Had two (2) or more emergency department visits, or two (2) or more hospitalizations due to SMI or SUD in past 12 months
- Is pregnant or is less than 12 months post-partum
Adults who are transitioning from incarceration
- Members who qualify are those who transitioned from incarceration within the last 12 months and has at least one (1) of the following:
- Chronic mental illness
- Substance use disorder
- Chronic disease
- Intellectual or developmental disability
- Traumatic brain injury
- HIV
- Pregnancy
Adults who have a diagnosed Intellectual and/or Developmental Disability and qualify for eligibility in any other adult ECM Population of Focus
Adults Living in the community and are at risk for long-term care institutionalization
- Members who qualify will have all of the following:
- Are living in the community who meet the SNF Level of Care (LOC) criteria; OR who require lower-acuity skilled nursing, such as time-limited and/or intermittent medical and nursing services, support, and/or equipment for prevention, diagnosis, or treatment of acute illness or injury;
- And are actively experiencing at least one complex social or environmental factor influencing their health (including, but not limited to, needing assistance with activities of daily living (ADLs), communication difficulties, access to food, access to stable housing, living alone, the need for conservatorship or guided decision-making, poor or inadequate caregiving which may appear as a lack of safety monitoring);
- And are able to reside continuously in the community with wraparound supports (i.e., some members may not be eligible because they have high-acuity needs or conditions that are not suitable for home-based care due to safety or other concerns).
Adult Nursing Facility Residents Transitioning to the Community
- Members who qualify will have all of the following:
- Are interested in moving out of the institution;
- And are likely candidates to do so successfully;
- And are able to reside continuously in the community.
What services does ECM provide?
ECM provides care coordination services led by a care team. The ECM care team will work together with the member’s health care providers including their doctors, specialists, pharmacists, case managers, and others, to coordinate the needed care and services.
Members enrolled in ECM will receive services including:
- A Comprehensive Assessment and Care Management Plan
- Enhanced Coordination of Care
- Health Promotion Services
- Comprehensive Transitional Care
- Member and Family Supports
- Coordination and Referral to Community and Social Support Services
Resources
- Department of Health Care Services Enhanced Care Management.
- KFHC Enhanced Care Management Brochure (English/Spanish).