Tailored Care Management Donna Stevenson, MA Senior Director, Payer and Practice Transformation dstevensonalliancehealthplan.org Has spent the last 30 months working with Tailored Care Management including running a Pilot Developed
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Tailored Care Management<br>
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Donna Stevenson, MA Senior Director, Payer and Practice Transformation dstevenson@alliancehealthplan.org Has spent the last 30 months working with Tailored Care Management – including running a Pilot
Developed resources and tools for use in becoming a certified TCM and operationalizing the program
Supervises 5 Practice Transformation Specialist
Works collaboratively with TCM entities and the Department to ensure Member needs are met<br>
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Serves 6 counties – Cumberland, Durham, Johnston, Mecklenburg, Orange and Wake
Supports approximately 56,000 Members
Alliances network includes providers offering mental health, substance use, I/DD and TBI services
Currently works with 1 AMH+ and 38 CMAs
Will take on additional CMAs and AMH+ in Round 3 of certification<br>
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Practice Transformation (PT) Alliance Practice Transformation team was created to:
Assist providers in transforming to value-based contracting
Implement Tailored Care Management (TCM)
Provide support to providers with the TCM programs
Provides additional trainings for Alliance providers
Offers a CMA Collaborative and a Supervisory Learning Collaborative
Provides technical assistance to agencies 1:1
Creates tools and resources for TCM agency’s use, they can be found at:
Provider Practice Transformation - Alliance Health (alliancehealthplan.org)<br>
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NC Medicaid and Tailored Care Management Kristen Dubay
Chief of Population Health
NC Medicaid, Department of Health and Human Services
September 19, 2023<br>
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Approximately 190,000 beneficiaries assigned for Tailored Care Management statewide
60% are assigned to LME/MCO care management teams
38% to Care Management Agencies (CMA)
2% to Advanced Medical Home Plus (AMH+) providers Map Note: Absolute numbers of beneficiaries with TCM assignment in each county as of 8/1/2023. Total Beneficiaries Assigned to Tailored Care Management Services, by County<br>
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Member Experience & Access to Quality Care Provider Enablement & Financial Support Communication & Engagement 192K Members with BH/IDD needs enrolled into TCM
116 TCM Assignments sent to LME-MCOs
22K Member choices recorded 71 TCM Providers Certified to Date
35 TCM Providers targeted to enter the field between October 2023 and February 2024
$116M in Capacity Building Funds distributed to LME/MCOs to support CMA/AMH+ providers 12 TCM Bulletins and Fact Sheets Published
5 Monthly TCM Newsletters Sent to TCM Providers
3 Provider Manual Updates Published based on Provider and Plan feedback.
6 TCM Technical Advisory Group (TAG) Meetings
1 TCM TAG Data Subcommittee Meeting
50 TCM AHEC Sessions
345 TCM Help Center Tickets Closed Technology and Data Support 588 TCM Data Interfaces Enabled
200 Technology Issues Triaged for Resolution
140 Technology Deep-Dive sessions facilitated since launch.
5 TCM Assignment Onsite Working Sessions with LME/MCOs Tailored Care Management Launch Metrics<br>
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NC Medicaid Tailored Care Management Priorities Maintaining TCM continuity of care for members
Examining reassignment rules to minimize inappropriate member reassignments
Resolving reports of member disruption to understand if system changes are needed
Financial Viability of Tailored Care Management Services
Distributed additional capacity building funds to address unexpected start-up costs and challenges
Comparing underlying rate assumptions to experience in the field & exploring alternate rate options
Reviewing TCM claims and payments
Examining potential TCM policy flexibilities to support financial viability
Working with Plans to increase CMA/AMH+ member panels
Increase Awareness of TCM Services among Members and Community Partners
Working with DMH to develop plain language materials for members, guardians, families, and providers.
Presenting to and engaging with provider organizations
Improve Accuracy and Completeness of Data Shared
Continue to support both Plan and Provider access to complete and accurate data shared through Tailored Care Management data interfaces.<br>
