3 rd Quarter MSHO/MSC+ Care Coordination Training

Transcription

1 3 rd Quarter MSHO/MSC+ Care Coordination Training Internal Care Coordinators & Care Systems: September 21 st, 2016 Recorded WebEx: September 28 th, 2016

2 Agenda Welcome/Introductions American Cancer Society-Bobbi Jo Glood/Jennifer Andersen STARS-Cindy Radke Model of Care-Bobbi Jo Glood/Jennifer Andersen PCA/EW Updates-Esther Versalles-Hester Care Coordination Update-Bobbi Jo Glood/Jennifer Andersen Silver Sneakers-refer to the posted WebEx on the UCare website.

3 Stars September, 2016

4 Medication Adherence Helps numerous Star measures *Blood Pressure Control *Diabetes Care Blood Sugar Control *Part D Medication Adherence for Cholesterol *Plan all cause readmissions

5 Interventions Late to refill letters sent August. August newsletter article. Work with members to identify reasons for non adherence.

6 Part C logs Continue to see assessment dates prior to date converted to MSHO. Remember to do product changes!!!! First year we can count refusals and unable to reach as long as completed within designated timeframes. Data validation in be prepared when file requests happen!

7 Other Star Measures? Care of Older Adult MSHO only measures Functional status assessment Pain Screening Medication Review Requests for data occur during HEDIS season beginning of Requests for HRA assessments- Care Plans- Any ability to pull medication reviews from EMR systems. Will be presenting more on these measures in December meeting and introduce our Quality Manager for HEDIS Chelsey!

8 Parting remarks Continue to work with MSHO members to close gaps in care. Work hard to close gaps before the end of the year! What can UCare do to assist? Remember the incentives offered!

9 Cancer Prevention and Early Detection Angie Rolle State Health Systems Sr Director American Cancer Society

10 Overview of Presentation Tobacco Cessation Cancer Screening Breast Cervical Colorectal 10

11 Tobacco Use is linked to 1 in 3 cancer deaths 90 percent of all lung cancers Increased risk of 14 other cancers including breast, cervical and colon 11

12 When talking to a smoker Talk about health benefits of quitting, especially immediate impact Consider the cost argument, cigarettes are not cheap Acknowledge that it is hard to quit but offer support and be patient with them 12

13 Immediate benefits of quitting 20 minutes after quitting Your heart rate and blood pressure drop. 12 hours after quitting The carbon monoxide level in your blood drops to normal. 2 weeks to 3 months after quitting Your circulation improves and your lung function increases. 13

14 Mid-term Benefits 1 year after quitting The excess risk of coronary heart disease is half that of a continuing smoker's. 2-5 years after quitting Stroke risk can fall to that of a non-smoker 5 years after quitting Risk of cancer of the mouth, throat, esophagus, and bladder are cut in half. Cervical cancer risk falls to that of a nonsmoker. 14

15 Long term benefits of quitting 10 years after quitting The risk of dying from lung cancer is about half that of a person who is still smoking. The risk of cancer of the larynx and pancreas decreases. 15 years after quitting The risk of coronary heart disease is that of a non-smoker's. 15

16 Consider the cost We all know that smoking causes a range of health problems, but have you thought about how it affects your wallet? Cigarettes and/or tobacco breath mints and cough drops cleaning expenses clothes, home, and car. Long term costs of doctor visits 16

17 Advice: Make a Plan Pick the date and mark it on your calendar. Tell friends/family about your quit day. Stock up on oral substitutes sugarless gum, carrot sticks, or hard candy. Think back to your past attempts to quit. Try to figure out what worked and what didn t work for you. 17

18 Ucare Quitline UCare members can get free help to quit smoking or chewing tobacco with the tobacco quit line. Counselors at the tobacco quit line are there to help Ucare members kick the habit. Nicotine patches, gum, or lozenges are also available to eligible UCare members at no charge when they call the tobacco quit line. Call the tobacco quit line at TTY/hearing impaired: The tobacco quit line hours are 7 a.m. to 10 p.m., Monday through Friday, and 10 a.m. to 4 p.m. on Saturdays. 18

19 Cancer Screening Benefits Screening offers the opportunity to detect cancers before symptoms appear Earlier stages are often more treatable Some cancer screenings can find problems before they become cancer 19

20 Cancer Screening Recommendations Breast, cervical and colon tests have broad support as cancer screenings Lung cancer screening is recommended for a small group of former smokers The value of current prostate cancer tests is a matter of debate 20

21 21

22 Breast Cancer and Age Nearly 8 out of 10 breast cancers occur in women older than age 50 A woman who is 70 is almost twice as likely to develop breast cancer in the next year as a woman who is

23 Breast Cancer and Family History Your risk is greater if a close relative has had breast cancer But only 20-30% of women with breast cancer have a family member with this disease. 23

24 24

25 Breast screening saves lives Over 98% of women diagnosed with breast cancer in localized stage were alive 5 years later Mammography screening can help women detect breast cancer in this early stage 25

26 Colon Screening 90% of men and women diagnosed with localized colon cancer are alive 5 years later Less than half of colon cancers are diagnosed in this early, more treatable stage 26

27 Why Test? There are two aims of testing: 1. Prevention Find and remove polyps to prevent cancer 2. Early Detection Find cancer in the early stages, when best chance for a cure

28 Benefits of Early Detection Survival Rates by Disease Stage* 5-yr Survival % 70.4% 12.5% Local Regional Distant Stage of Detection

29 Decrease in Incidence Decline due to: Screening polyp removal prevention Recent study estimates that screening has prevented approximately 550,000 cases of colorectal cancer in the US over the past three decades

30 Colonoscopy

31 Colonoscopy Limitations Greater patient requirements for successful completion Requires a bowel prep and facility visit, and often a preprocedure specialty office visit Access Limited by insurance status, local resources Patient preference Many individuals don t want an invasive test or a test that requires a bowel prep 31

32 What about stool tests?

33 Stool Test Types A) Tests that detect blood (Fecal Occult Blood Tests) Recommended by ACS, USPSTF and all major screening guidelines Two types (but multiple brands, variable performance) Guaiac based FOBT Immunochemical (FIT) B) Tests that detect aberrant DNA One test (Cologuard) available in U.S. Combines DNA mutation test with FIT Recently added to USPTF recommendations

34 Guaiac Tests Specific for human blood and for lower GI bleeding Results not influenced by foods or medications Some types require only 1 or 2 stool specimens Higher sensitivity than older forms of guaiac based FOBT Costs more than guaiac tests (but higher reimbursement)

35 Fecal Immunochemical Tests (FIT) Specific for human blood and for lower GI bleeding Results not influenced by foods or medications Some types require only 1 or 2 stool specimens Higher sensitivity than older forms of guaiac based FOBT Costs more than guaiac tests (but higher reimbursement)

36 Advantages of stool tests Less expensive No bowel preparation. Done in privacy at home. No need for time off work or assistance getting home after the procedure. Non invasive no risk of pain, bleeding, perforation Limits need for colonoscopies required only if stool blood testing is abnormal. 36

37 Inadomi, Arch Intern Med 2012 Patient Preferences

38 Many patients prefer stool tests Diverse sample of 323 adults given detailed side by side description of FOBT and colonoscopy (DeBourcy et al. 2007) 53% preferred FOBT Almost half felt very strongly about their preference 212 patients at 4 health centers rated different screening options with different attributes (Hawley et al. 2008) 37% preferred colonoscopy 31% preferred FOBT Nationally representative sample of 2068 VA patients given brief descriptions of each screening mode (Powell et al. 2009) 37% preferred colonoscopy 29% preferred FOBT

39 High Quality Stool Testing Clinicians Reference: FOBT One page document designed to educate clinicians about important elements of colorectal cancer screening using fecal occult blood tests (FOBT). Provides state-of-the-science information about guaiac and immunochemical FOBT, test performance and characteristics of high quality screening programs. Available at

40 Encourage Members to Talk to their doctor I m over 50, how soon can I get tested for colon cancer? I understand that there is more than one type of test for colon cancer. Should I consider a stool test? Is there a particular stool test that you would recommend?

41 Effective Messaging

42

43

44

45

46

47

48 When someone receives a cancer diagnosis they often have questions.

49 How can ACS help? Phone help: On the internet: Information Emotional Support Day-to-Day Help

50

51 Hope Lodge

52 Road To Recovery

53 UCare MSHO Model of Care 2016

54 UCare MSHO Model of Care 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.

55 UCare s SNP Population MSHO serves over 10,000 special needs dual eligibles The majority (70%) are women. 31% are minorities. 82% live in the community, 18% are institutionalized. >1 out of 3 members has 2-4 chronic conditions. >1 in 10 has 10+ chronic conditions. Top five most frequent health issues are: Hypertension (77%). Disorders of Lipid Metabolism (51%). Rheumatoid Arthritis /Osteoarthritis (44%). Diabetes (40%). Depression (37%).

56 UCare Care Coordination Care Coordination is the cornerstone of the MSHO Care Model. All MSHO members receive care coordination. Integrates Medicaid and Medicare services Includes MLTSS services. Care Coordinators are Qualified Professionals RNs and SWs. Coordinate member services, act as central point of contact.

57 UCare Care Coordination Care coordination consists of: Face to face Health Risk Assessment (HRA) Initially, annually, or if there is a change in condition. Development of an Individualized Care Plan (ICP) Ongoing coordination of full range of Medical services Behavioral health services Managed Long Term Supports and Services (MLTSS). Facilitation of communication (member, family, Interdisciplinary Care Team ICT). Care transition management.

58 Tailored Benefits and Services Extra benefits and services to promote healthy lifestyle, preventive care, safety. Health promotion programs (fitness, mammogram incentive, smoking cessation, UCare 24/7 Nurse Advice Line). Comprehensive medication reviews. Culturally competent staff Bilingual associate care managers, care coordinators, Customer Service reps, county and care system liaisons, providers. Care coordinators hired internally or contracted through counties, care systems, agencies. UCare model favors local level care coordination.

59 Provider Network Provider network meets the comprehensive needs of our members, including: 13,000+ primary care physicians. 15,000+ specialists. 9,800+ primary and specialty clinics dental providers. Critical access hospitals, geriatric services and nursing homes, DME, behavioral health, lab and X-ray, open access network. No referral required to contracted providers. Use DHS Tier 1 providers for MLTSS. Clinical practice guidelines available to providers. Model of Care training offered annually. Face to face or WebEx.

60 Quality Measurement & Performance Improvement UCare collects and analyzes data and reports from a variety of sources to: Evaluate the Model of Care. Identify improvements. Monitor and measure health outcomes.

61 UCare MOC Performance Goals Goal and Performance Measure Areas: Provider access. Member satisfaction. Care coordination HRA and care plan goals. Transition of care, preventive care, quality of health. HEDIS and Star measures : Breast cancer and colon cancer screening. Routine diabetic care. Depression medication adherence.

62 Data Sources for MOC Review UCare collects and analyzes data and reports from a variety of sources to evaluate the Model of Care and identify improvements based on these outcomes: Provider Geo Access survey. CMS Stars and HEDIS. Care coordination surveys. Analysis of enrollment and CC assignment data. Care plan and care transition audits. Clinical practice guideline claims review. MOC training for providers and CCs. Complaint reporting related to care coordination. Other data and ad hoc reporting.

63 Model of Care Challenges Member demographics present significant challenges: Age. Geographic location. Lack of integration of Medicare & Medicaid Services. Ethnicity, language barriers and cultural beliefs (many are immigrants). Lack of general and specialized transportation. Difficulty obtaining dental services. Vision and hearing impairments.

64 Challenges, cont. Multiple diseases and comorbidities. High medication use and side effects. Mental health and cognitive problems. Need for caregiver/caregiver support. End of life care needs. Low socioeconomic status combined with poor health literacy. Lack of provider engagement with care coordinator. Difficulty in getting providers to order tests or procedures that meet quality and Stars measures. Lack of available MLTSS providers.

65 How UCare Meets Challenges Extra benefits and services Medical and EW transportation Strong and Stable Kit, Silver Sneakers, Health Promotion Incentives. Interpreter services, bilingual staff. 24 hour Nurse Line. Culturally specific transportation when able. MLTSS. Caregiver training. Preventive care screening reminders. Align members with community resources. Mobile Dental Unit

66 MLTSS Services MLTSS Services designed to help members live independently: EW transportation. Homemaking. Meals on Wheels. PERS. ADC. Customized Living. Relocation services. PCA.

67 Clinical Liaison Staff to Meet Member Needs Works with Hmong members with complex medical/mental conditions, provides education to Hmong community- mbrs. and families. Diverse UCare staff Customer Service, and care coordination staff from diverse backgrounds. Somali, Hmong, Hispanic interpreters. Community support- community health workers, community sponsorships.

68 Member Outreach Efforts Call campaigns for preventive care Colon and breast cancer screening. Mobile Mammography. In-home osteoporosis screening. Diabetes care. Health coach calls for gaps in care. Partnership with WellShare International that started April 2016

69 Collaboration With Other Health Plans Collaborative Care Plan Transition of Care Process and Logs PIPs Depression Medication Adherence Work on assessment processes (MnCHOICES) Collaboration on audit processes and forms.

70 Successes Continual shift to community living. High levels of satisfaction with care coordination. Successful outreach for preventive care.

71 Shift to Community Living Community 73% 77% 80% 82% Institutional 27% 23% 20% 18%

72 Member Satisfaction with Care Coordination 97% are satisfied with their CC. 89% know who there CC is and how to contact them. 93% state their CC is respectful to them and their needs. 72% depend on their CC to assist with their health care needs. 89% Feel their CC has helped them maintain or improve their overall health. 85% feel their CC makes it easier for them to get care or services to remain safely at home.

73 Success With Member Outreach 100+ women received mammograms in last 18 months through local events. Increase in women receiving mammogram incentive vouchers. 278 in in in members returned colon cancer screening kits.

74 Summary Care Coordination is foundation of care model. UCare offers benefits and services designed to meet unique member needs. UCare meets challenges through innovative services, partnerships. Many successes.

75 PCA and EW Updates Presented by: Esther Versalles-Hester

76 PCA Updates UCare continues to engage Care System case managers with transition of the PCA assessment process. In the process of developing guidance and criteria to ensure compliance with DHS requirements. Due to delays with CFSS and MnCHOICE implementation, MCO s are engaging DHS in conversations regarding the current PCA process and expectations. DHS will be gathering data on the PCA assessment outcome for CFSS readiness.

77 Provider contract termination UCare notifies the assigned care system via authorization report in order for the case manager to assist in the transition process. It is vital that the report is processed expeditiously to avoid service interruption. CM s are reminded to contact the member or the RP to assist in securing a new provider. This includes EW services as well. UCare ends the current authorization on the provider contract term date and notifies the member via US mail.

78 EW Reminders All EW services require authorization for claims payment purpose. Please submit DTR s timely. UCare is required to provide an advance 14 day notice to the member and the provider of service reduction termination or denial. Please use current version (revised 5/2016) of the WSAF that includes drop down box for specific services. Verify provider NPI/UMPI and fax number prior to WSAF submission. UCare has received calls from the provider that the fax number listed on the WSAF is incorrect. Homemaker services that exceed greater than 5 hrs a week require care system supervisor approval. With the exception of PCA and Chore services, homemaking does not have flexible use and must be based on member plan of care and need not want. Change of EW providers. Please notify UCare via the WSAF when a member switches from one EW provider to another.

79 DME services covered under EW Case managers must ensure and document in the community support plan before purchase of the equipment or supply that the item meets all of the following criteria: Cannot be funded through any other source. If an item is never covered by MA, it is not necessary to seek a written denial from MA. If an item may be covered by MA, the medical supplier must seek authorization from UCare before seeking authorization of coverage under the EW program Specified in a community support plan as necessary to avoid institutionalization Meant for the sole use of the recipient Either medically necessary (appropriate and effective for the medical needs and health and safety of the recipient); or remedially necessary (appropriate to assist a recipient in increased independence and integration in their environment or community) Appropriate and effective for the medical needs, diagnosis, and condition of the recipient Of an acceptable quality Timely (that is, the accommodation is provided at the time it is needed) The most cost-effective health service available to meet the medical needs of the recipient An effective and appropriate use of MA waiver funds Cannot be funded through any other source.

80 EW Approval Reminders Example: Wheelchairs, Walkers, Lift Chairs, Canes, Hospital Beds. Most DME are covered benefits under Medicare and Medicaid and may require a physicians order. However, under the medical benefit, DME under $500 does not require an authorization from UCare. CM must exhaust all other payer sources i.e. Medicare or MA benefits prior to approving under the EW benefit. UCare has recently experienced issues with DME items that meet Medicare/MA criteria for which the CM is approving under EW. Questions on whether an item meets Medicare or Medicaid criteria can be submitted to the clinical services liaison for assistance.

81 Questions???? Please contact the Clinical Liaison at Or Esther Versalles-Hester at or

82 Care Coordination Updates Bobbi Jo Glood and Jennifer Andersen

83 Advanced Directives The CC must document on an annual basis that they addressed or discussed advance directives with the member. If an advance directive was not discussed, document the reason.

84 Advance Directives resource Fairview Health Services is a partner with Honoring Choices Minnesota, which brings health care systems together to promote the benefits of advance care planning. You can find Health Care Directives written in Hmong, Somali, Russian, and Spanish Website: mmitment/involvement/honoringchoices/index.h tm

85 UCare Mobile Dental Clinic The UCare Mobile Dental Clinic is returning to Minnesota roads this fall to serve eligible UCare members with preventive dental coverage. After a seven-month hiatus, the wheel-chair accessible clinic will be back in action beginning Aug. 29 in Roseville, Minn. It will offer care in 2016 at five Twin Cities metro area sites and also visit four sites in Greater Minnesota (here s the 2016 schedule). The 2017 service schedule will be available later this year.

86 Updated Requirements Grids For MSHO and MSC+: Updated as of to reflect changes related to Person Centered Planning and the addition of the Transitional Health Risk Assessment Form. Changes are highlighted in yellow.

87 My Move Plan Summary To help with the process of moving, DHS created the My Move Plan Summary, DHS-3936 to support MSHO and MSC+ members. This only applies to members who are open to EW. Requirements The Person-Centered, Informed Choice and Transition Protocol (PDF) requires care coordinators and support planners, to work together with the member who is moving to create this summary. If a member indicates Prefer to live somewhere else, or Don t know on question E.13 of the DHS-3428/LTCC, the care coordinator is required to complete the My Move Plan Summary document. Care Coordinator roles and responsibilities When using the My Move Plan Summary, the care coordinator should: Initiate the document s creation Build and share the summary with the member Inform the member about the process, including any changes to the plan Refer to the document throughout the move Update the document when it needs modification or changes Sign and keep a copy of the completed document in the member s file. This document can be found on the DHS edocs website.

88 DHS Bulletin-Comprehensive Policy on EW residential services This bulletin has been re-issued to include Person Centered Planning, new CL rates and the monthly-to-daily rate. There are no new policies. This bulletin can be found on the DHS website

89 Updated DHS forms DHS has updated the following forms and they can be located on the edocs website. LTC Screening Document-DHS-3427 LTCC assessment form-dhs-3428 Please download and use the new versions.

90 Updated MMIS manuals DHS has updated the following MMIS manuals as of July 2016, please begin to refer to the new manuals and destroy any old copies. DHS-4625: The Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS DHS-5020A: The Instructions for Completing and Entering the LTCC Screening Document into MMIS for the SNBC Program DHS-4669: The Instructions for Completing and Entering the LTCC Screening Document into MMIS for the MSHO and MSC+ Programs

91 Access & Password reset requests for MMIS Please begin to send your access and password reset requests to Bobbi Jo Glood & Jennifer Andersen via the .

92 DHS Best Practice Care Coordination Learning Day This Learning Day is Thursday, Sept. 29, from 8 a.m. to 4:30 p.m. at the Radisson Blu-Mall of America. You can either attend it in person or view it via Webinar. The event informs MSHO, MSC+ and SNBC care coordinators about new care coordination requirements and strategies for effective care coordination. Registration will open Aug. 17, 2016, and can be completed on the DHS website. During the registration process, you will be prompted to choose between on-site attendance or participation via Webinar.

93 Tidbits & Reminders Change in Care Coordination Delegate and Waiver Service Approval Forms We have learned that we have been receiving requests on our UCare Waiver Service Approval Form to end authorizations due to a change in care coordination delegate. Please note that we do not end authorizations due to this type of change. Authorizations will remain in place to avoid claim denials. If you have questions, please contact clinicalliaison@ucare.org. Part C Logs MSHO/MSC+ care coordinators are reminded that Part C logs are due on or before the 10 th of every month for the previous month s activity. If the 10 th of the month falls on a weekend, it is preferred that you submit your logs before the 10 th. All Excel spreadsheets must be ed to UCare at assessmentreporting@ucare.org care coordination satisfaction survey Thanks to all care coordinators who completed the annual UCare Care Coordination Satisfaction Survey! Your feedback helps us identify areas in which we can improve our current processes. We will be presenting the findings at the December quarterly

94 Tidbits & Reminders continued DHS-LTCC and Collaborative Care Plan Training If you were unable to attend the LTCC and Collaborative Care Plan Training on June 23, 2016, DHS has archived this training for viewing at a later date. This training provides valuable information on the updated LTCC and Collaborative Care Plan that became effective July 1, New DHS address for Residential Services (RS) Tool questions DHS has a new address for RS Tool questions, EWRShelp@state.mn.us. Please use this address rather than ing individuals at DHS directly to ensure that your questions are answered promptly.

95 Silver Sneakers