Coordinating Effective Care for Dual Eligibles Welcome and Introduction Aaron Crowell VP Business Development 17 years business and consulting experience Alaina Maciá President amp ID: 654213
Download Presentation The PPT/PDF document "Communities Without Barriers" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Communities Without Barriers
Coordinating Effective Care for Dual
EligiblesSlide2
Welcome and Introduction
Aaron Crowell
, VP Business Development
17 years business and
consulting experienceSlide3
Alaina Maciá, President & CEO
Ten
year MTM veteran
Implemented & led more than ten statewide & regional non-emergency medical transportation (NEMT) programs
Spearheading MTM’s expansion into new product opportunities
Member of Washington University’s Institute for Public Health National CouncilSlide4
Changing Healthcare Landscape
Healthcare reform
Focus on
Home & Community Based Service (HCBS) coordination
for dual eligible populations
Keeping members out of long-term care institutions and in their homes
$36,000 vs. $9,000 annual average
Based on 2008 national enrollment dataSlide5
Simulating the Village Lifestyle
Advancements have had unintended negative effects
Back to basics solutions
MTM’s HCBS model simulates the village atmosphere
Coordinated communities of HCBS providers partner with a Care Coordinator
Facilitates services that members need to stay in their homes safely & happilySlide6
About MTM
Established in 1995 to manage NEMT benefit for Medicaid & Medicare members
Contract with credentialed local transportation providers
Supported by Customer Service, Claims, Quality & Care Management departments
18
years of
experience improving health outcomes
URAC accredited
MO-certified WBE; IN & IL-certified affiliateSlide7
National Footprint
Business spans 28 states
Seven million trips managed annually
Three and a half million members served every year
Five customer service centers take in three million annual callsSlide8
Evolving with Our ClientsAs healthcare evolves, MTM evolves with it to meet clients’ needs
Acts as an integral part of member care plans
Expanding
to new service offerings
Ambulance authorizations & claims
adjudication
Call
center education & outreach
HCBS Slide9
Leveraging HCBS to Support Members
HCBS provides services that aging, ill & disabled populations need for a healthy, happy & social lifestyle
Meals
Home care
Home modifications
Home cleaning
Transportation
Companionship
A community-based social lifeSlide10
Utilizing Quality Service Providers
HCBS provider networks are readily available but unmanaged & uncoordinated
MTM’s model ensures cost effectiveness & quality
Network development staff
Credentialing & training
Uniforms & badges
Audits & satisfaction surveysSlide11
Supporting Your Case Managers
Care Coordinator acts as an extension of your teamSlide12
Supporting Your Case ManagersCare Coordinator connection leaves your Case Managers free to focus on clinical care
Simulates the village approach
Ensures quality services are provided in a timely manner
Reminds members & caregivers about appointments
Acts as a liaison between all involved parties
Schedules & coordinates social activitiesSlide13
Coordination ProcessCase Manager requests in-home OASIS assessment
Care plan developed in coordination with Case Manager & medical provider
Care Coordinator authorizes & arranges
HCBS
Services are provided
Payment for service authorizedSlide14
Leveraging Technology
State-of-the-art technology streamlines services
Prior authorization & claims processing software
Vendor management software
Eligibility
& encounter data processing systems
Web-based vendor portals
Smart phone appsSlide15
Coordinated Care Case StudyPatient: Margaret Smith
78-year-old female
Chronic kidney disease & diabetes
Dual eligible beneficiary
Hospitalized for broken hip & later discharged from a rehabilitation facility
86-year-old husband is primary caretakerSlide16
Mrs. Smith’s NeedsDME (walker)
Home modifications to ensure access
RN to manage medication
Home Health Aid for bathing & light housekeeping
Meal preparation/service for 60 days
Transportation to medical appointments & social activitiesSlide17
Coordinating Care for Mrs. SmithCare Coordinator augments care plan with social activities & transportation resources
Call Mrs. Smith for upcoming appointments, routine check ins & follow up on meals, medication, etc.
Oversight & management of HCBS providers
Real-time communication with feedback loop to Case Manager
Report outcomes & important milestonesSlide18
Benefits of Care Coordination Model
Improved continuity of care
Reduced service & communication fragmentation
Significant
cost
avoidance
Improved health outcomesSlide19
Proven Care Coordination Results
Studies show coordination reduces healthcare costs
University of Colorado Health Sciences Center
Conducted in 28 states
Nearly 158,000 participants
22% to 26% decline in hospitalizations
5% to 7% improvement in health outcomesSlide20
ClosingQuestions?
Contact MTM to learn more about how we can partner to address gaps in HCBS delivery as you expand into new markets
Free assessment of your organization’s needsSlide21
MTM is about improving members’ overall health & wellbeing by providing services to promote independence & remove barriers to healthcare while reducing costs to clients.