3 rd Quarter MSHO/MSC+ Care Coordination Training

Transcription

1 3 rd Quarter MSHO/MSC+ Care Coordination Training Care Systems & UCare Care Coordinators: September 13 th, 2017 Recorded WebEx: September 14 th, 2017

2 Agenda STARS Cindy Radke Bus Pass Transportation Jeremy Hyde Model of Care (MOC) Bobbi Jo Glood EW and PCA Esther Versalles-Hester Care Coordination Updates Dee-Ana Farness

3 Stars Update Quarterly meeting September, 2017 Cindy Radke,LSW Clinical Services Project Coordinator

4 2018 Star Ratings Timeline Plan Performance Data Collection Star Rating Payment

5 MSHO Clinical measures Measure 2016 Rate (2015 DOS) Breast Cancer Screening 2017 Rate (2016 DOS) Status Projected Rate 2018 (2017 DOS) 2 Star 3 Star 4 Star 5 Star NNT 65% 63% Decline 63% = 2 Stars 44% 63% 69% 76% 8 Colorectal Cancer Screening Diabetes Eye Exam Diabetes Kidney Disease monitoring Diabetes Blood sugar controlled Controlling High Blood Pressure SNP Assessment Reporting 61% 64% Improved 64% = 3 Stars 57% 64% 73% 83% % 81% Improved 86% = 5 Stars 51% 62% 74% 81% N/A 96% 91% Decline 92.4% = 2 Stars 92% 94% 96% 98% 33 80% 77% Decline N/A 53% 64% 76% 84% N/A 68% 71% Improved N/A 42% 57% 67% 77% N/A 82% 82% No change N/A 33.5% 54.1% 74.2% 92.9% N/A

6 Focus for the 4 th Quarter Work toward closing gaps in care for members before the end of the year. Breast Cancer Screening No physician order needed. Don t forget $50.00 Target gift card. We are doing engagement calls but calls from their own CC can be more effective. Colorectal Cancer in-home kit mailing/outreach. Diabetic Eye Exams/A1c/Nephropathy testing

7 SNP Assessment Reporting Product changes continue to be an issue. Ensure product changes are being conducted and reported on the logs. Ensure assessments being conducted within 365/30 days.

8 Closing Thank you for your continued partnerships and work towards closing gaps in care for our members! Don t hesitate to provide feedback to any ideas you may have to help members Available to speak to teams about Stars!

9 UCare Bus Pass Program Jeremy Hyde Customer Service Manager

10 Agenda Bus Pass Types / Service Area Metro Area Passes Non-Metro Passes Ordering Bus Passes Changes in eligibility Lost/Stolen cards Q&A

11 Metro Area Passes Metro Transit Pilot Pay as you go Go-To card Same card month over month No $ value loaded Utilization is tracked Cost is capped Metro Mobility Go-To card Order monthly Specific $ value loaded Riders with a disability / health condition

12 Non-Metro Area Passes Non-Metro Various types of passes (depends on area/bus company) Order monthly Specific $ value loaded Cloquet Hibbing Rochester Duluth International Falls St. Cloud Ely Mankato Virginia Grand Marais Pine City Wabasha Grand Rapids Proctor Winona

13 Bus Pass Tips Don t forget the Waiver Services Approval Form (WSAF) Bus passes for additional areas may be available through the county Fare Increases Most Metro Transit fares increasing $0.25 Most Metro Mobility fares increasing $0.50

14 Ordering Bus Passes Subject Line: Bus Pass Order Body/attachment: First/last name Address UCare ID Number DOB Type of card: Metro Transit, Metro Mobility rush non rush, Non-Metro area EW? (y/n)

15 Eligibility changes & lost passes Contact Most Go-to passes can be deactivated if lost, stolen, or a change in eligibility occurs In most cases we can reissue a bus pass if it is lost/stolen Counties / Providers (PRC and contracting) 3

16 Questions?

17 UCare Model of Care Minnesota Senior Health Options (MSHO) & UCare Connect + Medicare

18 UCare s Model of Care (MOC) Overall goal of the MOC: Drive improvements in health outcomes and quality of life for members. UCare s MOC is designed to: Increase access to affordable, cost-effective health care. Improve coordination of care. Ensure seamless transitions of care. Manage costs. 18

19 UCare Special Needs Plans (SNP) Minnesota Senior Health Options (MSHO): The MSHO program serves elderly members who are dually eligible for Medicare and Medical Assistance and are 65 years or older. Special Needs Basis Care (UCare Connect + Medicare): The UCare Connect + Medicare Program serves members with disabilities who are dually eligible for Medicare and Medical Assistance under the age of 65.

20 UCare Special Needs Plans Integrated products combining Medicaid & Medicare Parts A, B & D (pharmacy) Members have one ID card One phone number to call for health plan questions Over 11,000 members currently enrolled 10,000 with MSHO 1,000 with UCare Connect + Medicare 20

21 Why does UCare have a MOC? Required by CMS & DHS & has four components: Population description & characteristics Care Coordination details Provider Network to ensure adequate access Quality Measures & Process Improvement goals It helps provide: Appropriate access to primary & specialty care providers Integrates care coordination based on a member s Health Risk Assessment Ensures members receive individualized care plans Encourages and provides care transition support to members & families 21

22 Care Coordination The care coordinator (CC) coordinates care and services for the member which includes: Face-to-face Health Risk Assessment (HRA) annually which is used to evaluate members health risks, gaps in care and quality of life. An individualized, person centered care plan. Facilitating access to affordable care such as: medical, preventive, mental health and social services. Communicating with the Interdisciplinary Care Team (ICT), a team of professionals involved with the member to coordinate and provide health care services. Care Coordinators are Qualified Professionals Registered Nurses, Nurse Practitioners and Social Workers 22

23 Care Transition Protocols The care coordinator assists members, families, facilities, providers, or others with planned and unplanned transitions from one care setting to another. Examples include: Transition from hospital to home or nursing facility Goal is improved transitions to reduce fragmented care and avoid re-hospitalizations. 23

24 Provider Network UCare s provider network meets a wide range of needs. The network includes, but is not limited to: Primary care providers Specialists Primary and specialty clinics Dental providers The member may have care from any contracted provider without referral. Model of Care training is offered annually to all providers, delegates and UCare employees. 24

25 Clinical Practice Guidelines (CPGs) UCare adopts clinical practice guidelines to support good decision-making by patients and clinicians to improve health care outcomes, and meet state and federal regulatory requirements. CPGs are available on our provider website. 25

26 Quality Measurement & Performance Management UCare collects and analyzes data and reports from a variety of sources to: Annually evaluate the Model of Care. Identify improvements to be made for our members. 26

27 Summary Care Coordination is one component of our care model. UCare has two products with care coordination services MSHO & UCare Connect + Medicare which currently serves around 11,000 members. Care coordinators work with members, families and providers on transitions of care with a goal of reducing re-admissions. UCare uses data and reports to evaluate the Model of Care annually. 27

28 UCare Contacts Provider Assistance Center Phone: Clinical Liaison

29 PCA and EW updates Esther Versalles-Hester

30 PCA Reminder to CS who are conducting PCA on behalf of UCare Please complete assessment prior to authorization expiration date. Contact UCare if you can not reach member. UCare is the authorizing entity, please do not inform members that services can begin before the written authorization has been issued to the member and provider. Provider Change: New provider is required to complete the Provider Change form located on the Ucare website. Provider Contract Termination: UCare will contact impacted care managers to assist with the agency transition process. The new PCA agency is required to complete the PCA change form.

31 Elderly Waiver WSAF s Reminder to check calculations on approved units Ensure homemaking provider ID is correct Several request are received with the providers PCA ID rather than the EW ID. This creates issues with claims payment. EW provider who are not registered with UCare are required to complete the Povider Add form which is located on the Ucare website. Failure to complete this form may result in claim denials.

32 Questions or Inquiries Contacts For PCA: Please call option 2, option 4 For EW Please call option 2, option 6 Thank you.

33 Questions?

34 Care Coordination Updates MMIS Screening Requirements Provider Signature Requirements Disability HUB MN CC Survey Results CMS Audit

35 MMIS Screening Requirements DHS Training 07/20/17 New screening type H Assessments on or after 09/01/17 Identify MSHO/MSC+ members with PCA and not on EW Missing/Unable to Contact New assessment value 50 Screening type L Continue for MSHO/MSC+ EW members

36 Provider Signature Requirements Implementation 01/01/2018 Provider Letters DHS training December 7 th, 2017

37 Disability HUB MN The Disability Linkage Line (DLL) has been rebranded and is now called Disability Hub MN. This free, statewide resource network helps our members and anyone with disabilities: Solve problems Navigate the health care system and plan for the future Get answers to questions about health insurance options Learn about community living needs Discover employment opportunities Learn new skills Become aware of community activities The Disability HUB MN has all the same features of the DLL. UCare members and care coordinators can live chat, call or . Please use and promote the Hub as appropriate with your members and peers.

38 Care Coordination Survey Results 294 responses Questions regarding care coordination, training, notifications, audits, enrollment, authorizations Excellent feedback/suggestions!

39 Question 4 Clinical Care Coordination Liaison for care coordination questions 273 responses 82% are very satisfied to satisfied 9% are dissatisfied to very dissatisfied Feedback VM Sales Transfer paperwork Consistency Authorizations Enrollment Clinical Liaison role

40 Question 5 Training for care coordination 261 responses 90% are very satisfied to satisfied 10% are dissatisfied to very dissatisfied Tools and Resources on the website 262 responses 91% are very satisfied to satisfied 9% are dissatisfied to very dissatisfied Monthly newsletter and alerts 263 responses 97% are very satisfied to satisfied 3% are dissatisfied to very dissatisfied Feedback

41 Question 10 Job responsibilities as a care coordinator 265 responses 95% said YES 5% said NO Feedback Grids Training Checklists

42 Question 11 Suggestions to improve experience as UCare care coordinator 260 responses Feedback VM Grids Enrollment Admissions Checklists Individual Community Living Support (ICLS)

43 CMS Audit THANK YOU! Opportunities: Product changes (i.e. MSC+ to MSHO) Timely HRA s Refusal members Transition of Care logs Case notes Part C Log Plan of Care Signature page

44 Care Coordination Enrollment Roster Migration- Update What has been done: Care Coordination Enrollment Roster folder created on the secftp site. Credentials created for users who did not have access to the secftp site. Verification by users that they can see the Care Coordination Enrollment Roster folder.

45 Care Coordination Enrollment Roster Migration- Update What is left to do: IT will complete programing. Care Coordination Enrollment Rosters will be posted to both the extranet and secftp for one month Date to be determined. Care Coordination Enrollment Rosters will officially be posted to the secftp site. Date to be determined.. Extranet will sunset. Date to be determined.

46 Care Coordination Enrollment Roster Migration- Update Communication will continue to users as things continue to be completed. We want this to be as smooth of a transition as possible. Thanks to all who are involved in this process.

47 Clinical Liaisons Dee-Ana Farness, LSW Clinical Care System Liaison Bobbi Jo Glood, LSW Clinical Care System Liaison