Over the course of this 3-part Building and Expanding Case Management Infrastructure series, faculty from the Institute for High Quality Care, along with guest speakers and health center panelists, will explore the core program and service line components that make up complex case management programs, including: client outreach/initiation, panel management, referral management, partnerships, case management maintenance, and graduation/step down.  During these workshops, participants will review examples of complex case management workflows, team structure/responsibilities, protocols, and other resources specific to providing ECM services in LA County.  Participants will leave these sessions with templates, resources, and an increased understanding of ways they can build, expand, and standardize their complex case management programs.

Please note – these sessions are not intended as a substitute for case management skills training (motivational interviewing, health coaching, etc.).  Sessions will be focused on programmatic, operational processes and best practices.

Building and Expanding Case Management Infrastructure Series – Part 1: Initiation and “Graduation”/Step-Down

During this first workshop in the Building and Expanding Case Management Infrastructure series, participants will review complex case management program bookends – Recruiting/Initiating ECM Support and Graduation/Stepdown. Speakers from IHQC, health centers, and other experts in the field will share policies, workflows, and communication scripts that ECM staff can use to recruit, enroll, and initiate care with patients eligible for ECM services. They will also review case scenarios, graduation protocols, and assessments to help case managers work with patients as they transition out of these intensive case management supports. This workshop will also provide opportunities for participants to work with colleagues across LA County to troubleshoot common challenges related to recruitment, initiation, and ECM graduation.

During this training, participants will:

• Explore policies, workflows, eligibility definitions, and communication scripts that can be leveraged to help ECM staff recruit, enroll, and initiate care with patients eligible for ECM services.
• Review case scenarios, graduation protocols and assessments, scripts, and client engagement strategies to help case managers work with patients as they transition out of these intensive case management supports. We’ll also review expectations and sample protocols for ongoing monitoring and support of past ECM patients.
• Workshop common challenges to initiating and recruiting patients into ECM supports, particularly those patients who are new to your health center, with other health center case managers and experts across Los Angeles.

Building and Expanding Case Management Infrastructure Series – Part 2: Panel Management and Referral Management

During this second workshop in the Building and Expanding Case Management Infrastructure series, participants will explore program supports needed to effectively manage ECM panels and referrals to community partners. Speakers from IHQC, health centers, and other experts in the field will review key considerations for defining and managing ECM patient panels – including factors for defining panel size and risk stratification protocols. They will also explore systems and strategies case managers can use to effectively manage ECM referrals between other health care providers and community service providers. Participants will have opportunities to work with colleagues across LA County to troubleshoot common challenges related to managing patient panels and referrals.

During this training, participants will:

• Review key considerations for defining and managing ECM patient panels – including factors for defining panel size and risk stratification protocols. We’ll also explore clinic protocols for ongoing management and making adjustments to case manager panels.
• Explore systems and strategies case managers can use to effectively manage referrals between other health care providers and community service providers.
• Workshop common challenges to managing patient panels and referrals with other health center case managers and experts across Los Angeles.

Building and Expanding Case Management Infrastructure Series – Part 3: Partnerships and Case Management Maintenance 

During this third workshop in the Building and Expanding Case Management Infrastructure series, participants will review strategies for fostering effective partnerships and explore protocols for maintaining consistent engagement with ECM patients. Speakers from IHQC, health centers, and other experts in the field will explore strategies that case managers can use to build and maintain effective partnerships with social service agencies and community partners. Speakers will then review complex case management program components like case conferences, team communication channels, and building health coaching and self-management supports to maintain effective engagement with patients. Participants will also have opportunities to work with colleagues across LA County to troubleshoot common challenges related to maintaining consistent engagement with these ECM patients and partners.

During this training, participants will:

• Explore strategies that case managers can use to build and maintain effective partnerships with social service agencies and community partners in order to promote more timely access to social and medical services for their ECM patients.
• Review systems, workflows, and protocols case managers should leverage to maintain consistent engagement with their patients, health care provider partners, and other key stakeholders. Participants will discuss steps for creating and sustaining regular case conference reviews, building clear communication channels with key stakeholders, and build skillsets around health coaching and self-management support.
• Work with health center case managers and experts across LA County to troubleshoot common challenges to maintaining consistent engagement with these ECM patients and partners.

Presented by:

Bridget Hogan Cole, MPH, Executive Director, Institute for High Quality Care

Chris Hunt, MPH, LSSBB, Program Director, Institute for High Quality Care

Laura Collins, MSW, LICSW, Senior Consultant, Los Angeles, CA

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Course registration is limited to health centers participating in CCALAC’s CalAIM Training Program for small to medium size facilities. Consult with Ahana Singh, Clinical Services Project Manager, at asingh@ccalac.org to determine if your site is eligible to participate.

Instructor Biographies:

Bridget Hogan Cole, MPH, Executive Director, Institute for High Quality Care

Bridget Hogan Cole, MPH is the founder and Executive Director of the Institute for High Quality Care. She has a unique combination of education and experience in healthcare technology and public health administration, with more than 25 years of program leadership, organizational development, project development, and technology planning/implementation experience. Bridget has held operations, consulting, and administrative positions with community health centers, hospital systems, Blue Cross of California, Kaiser Permanente Foundation Hospitals, healthcare engineering firms, and divisions of the Hospital Council of Southern California. She led the development and expansion of Blue Cross of California’s statewide Telemedicine Program – a collaborative of more than 60 rural provider locations and multiple specialty resources to improve access to care through the use of telemedicine. 

For more than ten years, Bridget has led regional and statewide quality improvement and specialty care access programs; facilitated numerous panels and conferences; supported the design of funder/foundation initiatives and has been called upon as an expert resource on the advancement of quality improvement, specialty care access, and efficiencies across the safety net. 

Bridget holds a Master’s in Public Health from the University of California, Los Angeles, and a B.S. in electrical engineering and biomedical engineering from the University of Vermont. 

Chris Hunt, MPH, LSSBB, Program Director, Institute for High Quality Care

Since joining the IHQC team in 2009, Chris has been supporting health centers, county health systems, and community-based organizations build their capacity to plan, implement, and sustain quality and performance improvement initiatives. Chris oversees IHQC’s portfolio of programs, collaborating with IHQC staff, sponsors, and other key stakeholders in tailoring programs to help our clients achieve their goals. Leveraging his background in quality improvement and public health, Chris often leads trainings and coaches teams on topics like problem assessment and root cause analysis, project design, quality improvement science and strategies, measuring and monitoring impact, implementing and standardizing change, project management skills, and building effective teams, among others. He has supported teams in the design and implementation of initiatives aimed at improving diabetes outcomes, reducing wait times, improving operational efficiencies, implementing planned/proactive care, improving patient and staff satisfaction, and redesigning organizational infrastructure and support systems to expand organizations’ QI capacity. 

Prior to joining IHQC, Chris worked at LA Health Action, a Los Angeles-based health policy and advocacy organization. Chris also worked at Amgen, a biotechnology company in California, as a research associate. Chris attended the University of California, Los Angeles where he received a Master’s in Public Health with a concentration in healthcare management and policy. Chris also holds a B.S. in psychobiology from UCLA, and is a certified Lean Six Sigma Black Belt. 

Laura Collins, MSW, LICSW, Senior Consultant, Los Angeles, CA

Laura Collins is a behavioral health professional with strong experience in hospital and clinic patient care, primarily in behavioral health. She has worked extensively in inpatient and outpatient  medical and psychiatric settings, providing project implementation oversight, program management, clinical supervision and regulatory preparation support.

Laura is a seasoned coach and technical assistant helping agency leaders and provider teams improve their care.  Her recent work involves supporting the implementation of the Enhanced Care Management benefit for both the Health Plans and agency teams in southern and northern California.  She is also participating in California’s Systems of Care Grant as a coach for substance use disorder programs in 2 northern California counties.  Prior to 2022, Laura also supported the roll-out of the Health Homes pilots in San Bernardino and Los Angeles counties as both a practice coach and trainer.

Before joining HMA, Laura worked for 20 years with Harborview Medical Center in Seattle, most recently as a behavioral health administrator for inpatient and outpatient programs.  On the outpatient-side, Laura provided oversight of the hospital’s psychiatry clinic, which included a resident training program, medication management, psychology and social work services that adhered to evidence-based therapeutic treatment modalities.

At Harborview Laura also developed and managed behavioral health integration programs across the Harborview and UW Medicine Neighborhood clinic system and has presented and published on this model (Integrating Behavioral Health into Primary Care, Population Health Management).

Laura also served as interim chief operating officer for Del Amo Hospital, a freestanding psychiatric hospital in Torrance, CA. She provided oversight to daily inpatient and outpatient hospital operations, including intensive outpatient treatment, and supported programming models with a quality improvement eye for trauma-informed, patient-centered and evidenced-based practice.

Laura began her career as a social worker with a focus on housing and homelessness.  She earned a Master of Social Work degree from the University of Washington.