Care Management Entities (CMEs) provide accountable care for children with behavioral health needs who experience high costs and poor outcomes and are typically involved with multiple child-serving systems, for instance, child welfare, juvenile justice, and behavioral health.
CMEs must coordinate a range of services for these children, while ensuring that the child and family team drive the plan of care. These organizations must therefore be able to systematically review and control the use of services to optimize efficiency and appropriateness of care through utilization management.
This technical assistance brief outlines utilization management activities that CMEs should undertake – either directly (in-house) or by partnering with an external administrative services organization or managed care organization – to ensure access to appropriate services and supports while reducing unnecessary use of costly services. It profiles three CME models – in Wisconsin, Massachusetts, and New Jersey – to highlight variations in approaches. A companion brief focuses on quality management activities essential for a successful CME.