HMO with Caseworkers on the job....

The company, known as iCare, is an HMO designed for people who are disabled or elderly and who depend on the Medicaid program - or a combination of the Medicaid and Medicare programs - for health care.

They include some of the most vulnerable people in our society. Roughly half of the people in the health plan have mental illness, and 30% have a history of drug and alcohol abuse. Many of them have been disabled for most or all of their lives.

People with severe disabilities have far more complicated and costly health problems. They also can be much more difficult to manage.

ICare is owned by Humana Inc. and the Milwaukee Center for Independence, a non-profit agency for the disabled.

When people enroll in iCare, the health plan does an initial assessment on their needs. The company then closely monitors their care - for example, tracking whether they are following up on referrals to specialists or frequently visiting hospital emergency departments.

The company's care managers sometimes must go to a patient's home because he or she doesn't have a working phone.

Daase, the intervention specialist, refused to leave until one person in the health plan came to the door. The woman had been smoking crack cocaine that day. Daase was able to persuade the woman to get treatment, and she stayed sober for 10 months before a relapse.

JS Online: HMO's forte is high maintenance


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