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Organizational Issues and Solutions
Ashley Flinn
Leadership and Organizational Behavior- BUS 520
Dr. Tillman
October 30
th
, 2022
1
Organizational Issues and Solutions
The organization researched to provide specific solutions will be the OhioRISE (Resilience through Integrated Systems and Excellence) program through Aetna Better Health of Ohio. OhioRISE is a Medicaid-managed care plan for children and youth with complex behavioral health needs, including but not limited to mental health, substance abuse, juvenile justice, developmental disabilities, and others. Aetna Better Health of Ohio is the managed care partner for the program. This program serves youth eligible for Ohio Medicaid (either managed care or fee-for-service), are the aged zero-twenty, are not enrolled in a MyCare Ohio plan, and require significant behavioral health treatment needs, measured using the child. (1)
One of the areas of concern is how the care coordinators receive the contact information
for members from the Ohio Department of Medicaid (ODM.) Due to the COVID pandemic, face-to-face meetings are required for families to keep their Medicaid were put on hold and have not started again. The lack of members having to complete the face-to-face meetings is causing the member's information to come into Aetna without an accurate physical address, phone number, and mailing address. Since the first step to engage the member in the OhioRISE program is to contact and explain the program, the lack of correct contact information delays members the benefits they are eligible. In this brand-new program, the lack of correct contact information is one factor causing the care coordinator's frustration. As a consultant, it is easy to see that the care coordinators could be experiencing the affective component. This component is “an attitude is a specific feeling regarding the personal impact of the antecedent conditions evidenced in the cognitive component. This becomes the actual attitude, such as the feeling, "I do not like my job." (Uhl-
Bien, 2, p. 4-13)
2
Unfortunately, in researching the OhioRISE program, management has not been doing their part to ensure the employees' concerns about the lack of correct contact information are heard. Since the program started on July 1
st
, 2022, the employees' information is "we know it is wrong and not correct, but it is on you to attempt to find and document the new contact information." The care coordinators have four databases they can research to find new contact information, but the documentation is usually not updated. The management has asked Aetna Care Coordinators to attempt to locate the member’s contact information for each case they do not have phone numbers or addresses, twice per week, per case. This is causing care coordinators to waste hours of work each week, attempting to find information that is not there. One way to ensure the children of Ohio, who need this program, are getting all the benefits they are entitled to would be only to attempt to locate these phone numbers once per month and, if the
mail is returned, to end benefits for this member. If the member is not keeping their contact details up to date, they should not be getting the benefits. The ODM should also be completing face-to-face interviews now that the COVID pandemic is over and getting that information to Aetna immediately. While completing the consultation, it was observed that there is inconsistent documentation in the CANS portal. The CANS portal is o
ne of the databases that an employee of Aetna can access, their Care Management Entity (CME), or another individual who has completed the Child and Adolescent Needs and Strengths (CANS) assessment. The CANS has a
section to identify the parent or guardian's name, address, and phone number. If the CANS portal made this section be completed before the CANS assessment is submitted, this would ensure that the next person who needs to contact this member will have accurate contact details. 3
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