Enhanced Care Management (ECM) is delivered primarily by community-based entities that hold contracts with managed care plans (MCPs).
L.A. Care assigns each potentially eligible ECM member to an ECM provider. ECM Providers are required to assign a Lead Care Manager to each ECM enrolled member. The lead care manager serves as the member's primary point of contact and works with all their providers – such as doctors, specialists, pharmacists, social services providers, and others—to make sure everyone is in agreement about the member's needs and care.
The ECM Provider's multi-disciplinary care team consists of the following roles and/or functions, at minimum:
- Lead Care Manager(s) — a paraprofessional or non-licensed professional or licensed professional
- ECM Director — has the ability to manage multi-disciplinary care teams
- ECM Clinical Consultant(s) — a licensed professional who can act as a clinical resource for the care team, specifically to support non-licensed Lead Care Manager(s)
- Community Health Worker — not required, but strongly recommended; a paraprofessional or peer advocate and/or administrative support to the Lead Care Manager(s)
ECM Provider Roles and Responsibilities
Each ECM-eligible member is assigned to a contracted ECM provider for outreach and engagement. This provider would also be able to provide the other ECM services should the member opt-in to the ECM benefit.
Members are matched to ECM providers based on many different characteristics, such as primary care, behavioral health or specialty. For example, if the member's Primary Care Provider is a contracted ECM provider, the member could be assigned to their PCP for ECM services.
A member may choose a different ECM provider organization or a different ECM Lead Care Manager if desired by notifying either their current ECM provider or L.A. Care.