UHC Care Coordination 11017 KS Ombudsman Lunch n Learn Katie Hooks amp Cynthia Houser Associate Health Service Directors Focus Personcenteredness Promotion of independence amp quality of life Closure of gaps in the treatment of acute chronic comorbid and other conditions that impact healt ID: 761962
Download Presentation The PPT/PDF document "UHC Care Coordination 1.10.17 KS Ombudsm..." 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.
UHC Care Coordination 1.10.17 KS Ombudsman Lunch n Learn Katie Hooks & Cynthia Houser Associate Health Service Directors
Focus Person-centeredness Promotion of independence & quality of life Closure of gaps in the treatment of acute, chronic, co-morbid and other conditions that impact health & self-careIntegration of medical, behavioral & LTSS 2 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Non-Waiver Care Management 3 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Waiver Care Management 4 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
HCBS Plan of Care Process 5 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
HCBS Contacts *TA members are contacted monthly. All member are reassessed with a change in condition.
HCBS Assessment Process 7 Person-Centered Member choice of attendees, time, date, etc. Goal development Back-Up plan development Rights & responsibilities Abuse, neglect or exploitation Integrated Service Plan Member choice of HCBS services, provider & self/agency direction Referrals for other necessary services (i.e., medical, behavioral, & community resources) Continuation of current services for transition members until assessment completed Appeals & grievance rights Comp. Health Status Assessment (CHSA) HRA REL/Disability Race, Ethnicity, Language SF-12 Behavioral/Depression Assessments Key Components LTC Functional Assessment Needs Assessment
NF Contacts 8 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Nursing Facility Assessment Process 9 Person-Centered Member choice of attendees, time, date, etc. Goal development Back-Up plan development Rights & responsibilities Abuse, neglect or exploitation Integrated Service Plan Continuation of current services for transition members until assessment completed Appeals & grievance rights Comp. Health Status Assessment (CHSA) HRA REL/Disability Race, Ethnicity, Language SF-12 Behavioral/Depression Assessments Key Components LTC Nursing Facility Needs Assessment
Interdisciplinary Teams 10 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. Assists with identification of potential members that can transition & barrier identification Assures the appropriate provision & utilization of HCBS services Assures the appropriate provision & utilization of AT/MHM services Provides a forum to discuss members with complex needs
Other Programs 11 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Community Transitions 12
Community Transitions: Impacting Health Outcomes and Cost 13 In 2015 and 2016 YTD: Members Assessed for Transition: 800+ Transitioned to Community: 305 (does not include transitions after short term stays such as rehab) Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. Objective Help individuals live in the safest and most independent setting possible Outcomes Key Capabilities and Innovation Four dedicated Community Transitions Case Managers + a housing coordinator Extensive staff training on Motivational Interviewing techniques to support members and better understand and remove barriers to transition Creation of “ transitional living services workbook ” to clarify roles and responsibilities between the internal and external members of the transition team (MCO, TLS provider, other HCBS providers) In 2015 and 2016, nearly $20,000 paid through creative use of “in lieu of” funds to facilitate safe, successful transitions (security deposits, first months rents, household items). Examples include:$8,840 paid to TLS providers over a 17 month time period to facilitate transitions in areas with limited TLS availability.+$2,000 in security deposits and first months rentKey Focus AreaHousing:Hired “Housing Navigator” position to support identification of safe and affordable housingDeveloping network of housing managers for rapid placement
Community Transitions: The Path to Home 14 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. Identify Identify individuals interested in transitioning to community setting, using initial assessment Assess Complete comprehensive assessment of member goals, needs and barriers Plan Co-develop comprehensive transition plan including connections to community supports Engage Engage community and provider partners in securing transition resources and supports Transition Transition member from institutional setting to community, with constant supports and re-assessments Maintain Engage consumer on a regular basis to identify emerging issue or needs to maintain community placement
Questions?? 15