1 st Quarter MSHO/MSC+ Care Coordination Training March 13 th -Care Systems and Internal Care Coordinators March 14 th -Recorded WebEx

Transcription

1 1 st Quarter MSHO/MSC+ Care Coordination Training 2018 March 13 th -Care Systems and Internal Care Coordinators March 14 th -Recorded WebEx

2 Agenda CAHPS Survey Emily Eckhoff Behavioral Health Malanie Blanchard 2017 Care Coordination Survey Results Bobbi Jo Glood Care Coordination Updates Bobbi Jo Glood

3 Member Experience Survey (CAHPS ) CMS Star Ratings

4 Member Experience Survey What is it? Confidential survey asking members to describe their healthcare experiences Recipients are randomly selected Goal is to improve healthcare services for our members Mailing Details Survey comes in a large white envelope from UCare and DSS Research (UCare s survey vendor) Sent in early March. DSS Research will call members to help them fill out the survey. Members can also receive help from caregivers, interpreters or you, their care coordinator. Encourage members to return survey in pre-paid envelope by the end of May.

5 Why is this survey so important? 9 survey questions are part of Stars Allows members to compare plans based on quality Determines a portion of Medicare funding. If UCare receives high survey scores, there is an opportunity to earn money that is invested directly back into our members.

6 Survey-Taking Tips If a member receives the survey, express the importance of their feedback! Encourage members to take their time, because the answers count for a lot. Read carefully and rephrase the question if needed.

7 Example #1 Using any number from 0-10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your healthcare in the last 6 months? Only the lowest and highest responses count in this survey. If you re happy, give us a 10! Remember, UCare does not receive individual member feedback so if you have an issue, it s best to give UCare a call directly.

8 Example #2 In the last 6 months, how often was it easy to use your prescription drug plan to fill a prescription by mail? Some questions may not apply to you. If you don t receive your prescription(s) by mail, skip this question!

9 Example #3 Wait time includes time spent in the waiting room and exam room. In the last 6 months, how often did you see the person you came to see within 15 minutes of your appointment time? Say you arrive 15 minutes before your appointment time of 3:00 p.m., then see the doctor at 3:10 p.m. Although you waited a total of 25 minutes, you still saw the doctor within 15 minutes of your appointment time.

10 Example #4 In the last 6 months, how often did your health plan s customer service give you the information or help you needed? UCare strives to provide great customer service. Yet we may not always give you the answer you expect due to health plan features and other rules. Use this survey to tell us how well we treated you with the courtesy and respect you deserve.

11 Survey Questions/Concerns If a member expresses grievance Call into UCare Customer Service UCare will not receive specific feedback expressed on the survey All survey related questions can be answered by our trusted vendor, DSS Research Call DSS Research s customer service line: For English: # For Spanish: #

12 Health Outcomes Survey (HOS ) CMS Star Ratings

13 Health Outcomes Survey (HOS) What is it? Annual baseline survey of 1,200 randomly selected members per product Administered from April to July DSS Research sends self-administered mail survey with telephone follow-up Measures how often providers discussed certain preventive health subjects with patients Improving or Maintaining Physical Health Improving or Maintaining Mental Health Monitoring Physical Activity Improving Bladder Control Reducing the Risk of Falling

14 Survey-Taking Tips If a member receives the survey, express the importance of their feedback! Encourage members to take their time, because the answers count for a lot. Read carefully and rephrase the question if needed. Since a member may consider you part of their care team, make sure to talk with them about the subjects measured in this survey.

15 MSHO & MSC+ Care Coordinator Behavioral Health Update 2018

16 Mental Health Update Twin Cities Mental Health Crisis Line Use any cellphone provider and dial **CRISIS Connects caller to their county crisis team Available in Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington Long-term goal is to replace a list of 30 county crisis numbers and have one central 800 number for rural areas and people without cellphones Mental Health Services in the Home Several mental health services can be provided in the home There must be a reason the member cannot leave their home, or the service is intended to increase independence in the home Psychotherapy, ARMHS, MH-TCM, ACT, Crisis Management, and Peer Support are common services provided in the home

17 Mental Health Update Providers Eligible Members Service Provided Impact on Care Behavioral Health Home (BHH) PCC or Mental Health Clinic Certified by DHS On Medical Assistance and has a serious mental illness or emotional disturbance 6 core services (care management, care coordination, health & wellness, trans care, support, and referrals) Model of care focused on integration of primary care, mental health services, and social services and supports Certified Community Behav. Health Clinic (CCBHC) Six clinics certified to participate in the CCBHC federal demonstration pilot Receive an eligible CCBHC services from one of the six clinics or a crisis assessment A variety of mental health and chemical dependency services. There are required core services and some services may differ from clinic to clinic Federal pilot measuring how an integrated community clinic model of care & payment can improve service quality and accessibility

18 Mental Health Update Geriatric-Psychiatric (geri-psych) Inpatient care due to a neurocognitive disorder and increased behaviors Barriers to discharge include: behaviors, medications, family, and facility availability Awaiting guardianship from the county has become a barrier Geri-psych units: United, Fairview/M Health, Unity-Mercy, Mille Lacs, Regina, Ridgeview, Sanford, Meeker, Lakewood, and Avera Mckennan Units often screen members before admission to determine if appropriate for geri-psych Care Coordinators can greatly impact the plan of care and transition with this population The behavioral health team has seen an increased length of stay on the metro area geri-psych units

19 Substance Use Disorder Update Substance Use Disorder Reform Chemical dependency (CD) will now be referred to as substance use disorder (SUD) MN Legislature passed a significant SUD reform bill created by DHS The goal of the bill was to increase access and treatment options There will be two parts of implementation; July 2018 and July 2019 The long-term plan is to phase out the Rule 25 assessment and move to a comprehensive assessment SUD and Seniors Many SUD treatment residential facilities are not able to accommodate an elderly population Members with a SUD are often not assessed or referred to treatment There are some long-term care facilities that will admit seniors with a SUD and provide treatment The behavioral health team has seen an increase in court ordered treatment in our Medicare only population. 19

20 MSHO and MSC+ Member Satisfaction Survey DECEMBER 2017

21 Survey Overview Objective: Assess member satisfaction with care coordination Improve care coordination based on member feedback Topic areas: Satisfaction with Care Coordinator Satisfaction with Care Plan Satisfaction with Care Coordination in General General Comments

22 Distribution Random distribution of surveys Community members surveyed Members in care coordination at least a year 19% response rate for MSHO 10% response rate for MSC+

23 Overall Results Most members satisfied or very satisfied with their care coordinator (CC) I know who my care coordinator is and how to contact them MSHO MSC+ 86% 83% My CC is respectful 90% 87% Overall satisfaction with CC 92% 89% CC makes it easier to stay in home yes or sometimes 78% 78% My CC asks for input into care plan 78% 78%

24 Summary 24 Response rates down slightly from 2016 Response rates to individual questions similar to 2016 or slightly improved Most members satisfied with care coordinator and care plan development Over 50% report CC assisted with pain management Over 70% report CC assisted in improving quality of life

25 General Survey Comments Most were positive Some complimented CC by name Many expressed gratitude for care coordination Dissatisfaction expressed related to reduction in services

26 Opportunities for Improvement Continued focus on member Input into care plan Person centered focus Knowing CC name Knowing plan of care shared with PCC

27 Questions/Comments

28 Care Coordination Updates

29 Care Coordination Questions We want to be a great resource to you when you have care coordination questions and to help us help you, please include as much detail as possible with your question(s); e.g.: Member name and ID number. Product they are on. Date of birth. Details about the situation. Your name, phone#, and address. This information will allow us to research the situation and provide you with an accurate and prompt response.

30 Care Coordination Questions cont. We do ask that you round with your team and supervisor prior to sending an as they are a great resource and may be able to guide you through your question. After rounding with your team should you still be unclear with the answers you received we ask that you send one outlining the question and then share it with your team after we have responded.

31 Member s coverage via MN-ITS Care Coordinators should be reviewing MN-ITS to: Ensure the member is assigned to UCare. Ensure there was no break in coverage when member is shows as new on the care coordination enrollment rosters and were previously assigned. If a member has a break in coverage they should be treated as a new member. If a member does not have a break in coverage you would want to document this and continue care coordination as usual.

32 EW Members in 90 day grace period MSHO and MSC+ members who are on EW and are in their 90 day grace period Care Coordinators should: Send the DHS-6037 and all accompanying documents to the County by day 60 if MA has not been re-established. This alerts the County that the person has lost MA and that the MCO will stop following the member at day 90 if MA eligibility is not re-established. Refer to the process as outlined on the requirements grids.

33 Waiver Obligations A waiver obligation is similar to a deductible for waiver services. Some members must pay a dollar amount (designated by DHS) out of pocket each month for waiver services, before UCare will pay the provider for services. The waiver obligation is deducted from the first provider bill for EW services received by UCare each month. Once the waiver obligation is satisfied, UCare will pay providers as they bill. Waiver providers are responsible to bill members directly when a member has a waiver obligation. The provider must first submit the claim to UCare for services rendered. The provider will then receive an Explanation of Payment (EOP).

34 Spenddowns Spenddowns are when members must spend down or pay, a part of their income each month to become or stay eligible for MA and MSHO or SNBC. This amount is determined by DHS (County Financial Worker) The spend down is what a member pays each month which then provides their MA coverage for the following month. The member pays DHS directly unlike a waiver obligation where they pay providers. If the member fails to pay their spenddown DHS could dis-enroll the member from the Health Plan.

35 Interdisciplinary Care Team Who needs to be included? At minimum, the member, PCP, Care Coordinator. Any providers who regularly see the member need to be included Psych or CD providers. Therapists- PT, psych, etc. Regularly can mean once/twice a year or more. We will look for this on audit

36 UCare Secure Site UCare cannot open 3 rd party secure s. When sending member PHI to UCare Care Coordinators must send it via UCare s Secure site: innesota& If you do not have an account you will need to register.

37 UCare Website UCare will have a new website mid-april. This will offer a fresh look and feel. All your tools/forms will still be there. Please take some time to familiarize your self and should you have any questions please reach out.

38 Clinical Liaison Contact Ceil Boesche and Bobbi Jo Glood