The Care MAP Tool is intended for Safety Net primary care organizations to help them explore the business case considerations for building and expanding their complex care management supports for their high risk, complex patients. By understanding how multiple factors influence the value proposition and financial viability of a complex care management service line, teams and leaders can be strategic in if/how they design, structure and scale these services in their organizations.

Please Note: The Care MAP tool is only intended as a framework to support considerations around complex care management in a clinic setting. The tool is not intended for final staffing, clinical, administrative, operational and/or financial decision-making.

The Care MAP tool focuses specifically on an organization’s Tier 3 patients – those who have complex medical and social needs and are considered high risk of hospitalization and other serious medical episodes. The tool focuses on this specific patient population because:

1. While other risk tiers have current reimbursable care management supports (e.g., CalAIM’s ECM supports for Tier 4 patients), Tier 3 patients typically have limited reimbursable supports; and
2. We’ve seen limited care management supports built and tailored for this specific patient population’s needs.

Because the Care MAP tool is a Microsoft Excel file, your team can tailor the tool to meet your organization’s needs. You may consider refinements to risk tier definitions, to reorganize sections reflect differences in service offerings at different clinic locations, add rows and columns to include additional line items or factors. If you do you make changes to the template, be sure to check and update output cells to ensure that new data inputs are being included.

Please note – the intended purpose and hence the categories, references, and questions for consideration were specifically focused on complex care management modeling for Tier 3 or high-risk patients.  Adaptations to the Care MAP tool beyond the original intended use are at the sole risk of the organization and/or user of the tool.

We’d recommend convening a multidisciplinary team with the relevant expertise needed to complete the Care MAP tool – clinical care delivery and staffing models, operations, finance, and quality. Review the tool prior to convening the team, make notes for what data elements each team member should bring to the meeting, and make note of which data elements might be challenging for your team/organization to generate. When completing the tool, it is intended that you begin with the first worksheet, “Population”, and work sequentially through the worksheet because each worksheet after that pulls from data inputs from prior worksheets.

The Care MAP pulls information and data from a variety of healthcare components – care delivery, operations, finance, and quality. To that end, we’d recommend either completing it as a team. Alternatively, a team lead could also choose to first work with team members with the relevant expertise individually, completing one Care MAP worksheet at a time, and then reconvening the full team to review the entire Care MAP.

Because this tool pulls from a variety of clinical, operational, and financial inputs, it is common for teams to find that, as they are completing the worksheets, they may not have the necessary information needed complete the worksheet. Consider reviewing the tool prior to meeting as a team to highlight which data elements might be more challenging for your team to pull and generate.