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Making Our Health Care System Work for Older Adults and Peo Making Our Health Care System Work for Older Adults and Peo

Making Our Health Care System Work for Older Adults and Peo - PowerPoint Presentation

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Making Our Health Care System Work for Older Adults and Peo - PPT Presentation

John Arnold OCVIC Project Director jarnolduhcanohioorg 6144560060 x237 Making a difference Together Ohio Chapter of GAPNAs 7th Annual Continuing Education day Why Your Voice Matters ID: 271488

health care medicaid medicare care health medicare medicaid mycare ohio providers plans plan consumer services eligible state consumers uhcanohio

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Slide1

Making Our Health Care System Work for Older Adults and People With Disabilities

John ArnoldOCVIC, Project Directorjarnold@uhcanohio.org614-456-0060 x237

Making a difference Together

Ohio Chapter of GAPNA's 7th Annual Continuing Education day

“Why Your Voice Matters”

March 14, 2015Slide2

The ProblemLimited care coordination

Fragmented CareCurrent system is confusing and difficult to navigateMultiple health care needs and high costThe health care and long-term care systems are not connected very well, even though people use both. 2Slide3

The Need

People with both Medicare and Medicaid are among Ohio’s highest need patientsThey are shuttled between multiple doctors who do not communicate with each other or recognize the whole person they are supposed to serve. As a result, these consumers often suffer from unnecessary tests, contradictory therapies and ineffective treatment.3Slide4

Dually Eligible in Ohio

4Currently Enrolled: 182,000 Ohioans9%

91%

40%

60%Slide5

Dual eligible beneficiaries are a

diverse population5Slide6

6

Cognitively or Mentally Impaired

3+ Chronic Conditions

In Fair or Poor Health

Dual Eligible Consumers are sicker than

other

Medicare Consumers

Functionally ImpairedSlide7

Answer7

A coordinated, managed care system that brings together all consumer needs and services under one umbrella called MyCare Ohio Healthcare doctor & Hospital

Long term Care (Passport,

Assisted Living, nursing home care)

Behavioral health/mental healthSlide8

MyCare Ohio

Demonstration to test integrated care and financing model for individuals with Medicare and Medicaid May 2014 to December 2017Federal and State partnership How it will work: Approved ICDS Plans will provide integrated benefits to Medicare and Medicaid enrollees in seven targeted geographic areasPlans must provide all necessary Medicare and Medicaid-covered services, including Medicaid waiver services Single identification card to access services 8Slide9

MyCare Ohio

Three-way contract (Health plan, CMS, State)Rolling start in mid-2014; passive enrollment in Medicare delayed until January 1, 2015Capitated rates adjusted for State and CMS upfront savings; also quality withholdComprehensive care plans required incorporating client and family goals9Slide10

Medicare Passive Enrollment (I)

Beneficiaries must participate in MyCare Medicaid; but Medicare is optionalOn 1-1-2015, individuals who have not indicated a choice, was passively enrolled in MyCare Medicare with the same health plan as their MyCare Medicaid (integrated benefits and funding)10Slide11

Medicare Passive Enrollment (II)Individuals can choose to stay with traditional Medicare or another Medicare Advantage plan

Beneficiaries can switch from MyCare Medicare to traditional Medicare, or vice versa at anytimeThis is all very confusing to consumers and public education has been poor 11Slide12

MyCare Ohio Demonstration

12Slide13

Health Plans by Region13

Northwest: Aetna and BuckeyeSouthwest: Aetna and MolinaWest Central: Molina and BuckeyeCentral: Aetna and MolinaNortheast Central: CareSource and UnitedEast Central: CareSource and UnitedNortheast: Buckeye, CareSource, UnitedSlide14

Who's Eligible?Age 18 and older at the time of enrollment

Eligible for full Medicare Parts, A, B, and D and full Medicaid, andReside in an ICDS Demonstration countyOhio Home Care or Transitions Carve-Out WaiversReceive AoD and/or Mental Health ServicesPassport or Choices WaiverAssisted Living Medicaid Waiver receiving Medicare and Medicaid14Slide15

You're Not Eligible if You're:

Under the age of 18On a delayed Medicaid spend down – (Delayed)If other third party creditable health care coverage is availableA person with Intellectual Disabilities (ID)or Developmental Disabilities (DD) served through an IDD 1915(c) HCBS waiver or an ICF-IDDEnrolled in PACEParticipating in the CMS Independence at Home (IAH) demonstration15Slide16

The Promise

16Single Point of ContactSingle ID Card for all Medicare and Medicaid ServicesNurse Advice Live – 24 hours a day, 7 days a weekCare Team – (Family, doctor(s), Care Coordinator, MyCare Ohio health plan, anyone else chosen) Better Care Coordination = Better Health outcomesProviders submit claims to 1 place Focus on Prevention and WellnessSlide17

The Promise (II)

17Slide18

Benefits for Primary Care ProvidersIdentifiable care manager – phone and email contact

Access to all benefits and servicesOpportunity to enhance home and community-based servicesWEB portal to access patient’s care planAssistance for your most complex patientsOpportunity to participate as part of Integrated Care TeamPotential to shift hospital dollars to community-based services18Slide19

Continuity of Care and Transition Requirements

Health plans must ensure individuals have access to current providers and service levels at the time of enrollment.Length of transition period differs by service. For prescription drugs, Medicare Part D transition requirements apply.Health Plans must provide a one-time fill- 30 day supply- of an ongoing medication within the first 90 days of plan membership.Residents in long term care facilities can receive multiple fills. 19Slide20

Continuity of Care Requirements (Continued

)During the transition, Health Plans will advise enrollees and providers that they have received care that would otherwise not have been covered. Ongoing basis, Health Plans must contact providers not part of their network with information on being credentialed as in-network providers. Health Plans must always reimburse an out-of-network provider of emergent or urgent care. Details: Plan Payment Requirements20Slide21

Cost of Inaction21Slide22

Crisis in Quality22Slide23

Implementation Issues

Consumers losing Independent Providers (Homecare and Nurses)Non-medical Long-term Services and Support –under 60Transportation issuesPrimary Care Providers – turning away patientsDurable Medical Equipment –not authorized 23Slide24

Ohio Consumer Voice for Integrated Care“What we do”

24

Consumer

Advisory

Council

Regional

Networks

SWOC, NEOC

Central

State –ODM

Federal - CMS

PlansSlide25

Critical Role of Provider and Consumer Engagement

Dual eligible patients will benefit from your participation in planning and direct care provision in MyCare OhioIf MyCare Ohio is not successful, the alternatives may be less desirable for patients and providersPrimary care and Geriatrics providers’ clinical leadership, when combined with consumer advocacy efforts, is more likely to have an impact25Slide26

How can Providers Get Involved?

Learn about MyCare OhioDiscuss good and bad observations with your health system, Area Agency on Aging, health plan medical directors, and State Medicaid office leadershipJoin advocacy organization list-servesHere’s the sign up link: http://uhcanohio.org/ocvic/primarycareproviders26Slide27

What You Can Do?“Vision”

Be part of the solution Help recruit consumer spoke persons to share their storyIdentify and help recruit others to join Consumer Advocate Conference call – (last Friday of every month) The call in number (free call) and participant code is: (877) 366-0711Participant code - 53257144#Provide a feedback loop to the Plan, Regional and State Coalitions.

27Slide28

Thank you

John Arnoldjarnold@uhcanohio.org614-456-0060 x23728

UHCAN Ohio

Ohio Consumers for Health

@

UHCANOhio

@

KathleenOCHC

Visit

www.uhcanohio.com/OCVIC