HealthCare IT Solutions. Supporting Medicaid from Start to Future

Transcription

1 HealthCare IT Solutions Supporting Medicaid from Start to Future

2 The success of any state s Medicaid strategy relies on selecting a core partner with a proven, next-generation, certified system; Medicaid-proficient staff; and a corporate track record that demonstrates the ability to deliver what it promises. Healthcare IT Solutions: Supporting Medicaid from Start to Future Molina is a national leader in administering high quality, cost-effective information technology services and managed care for Medicaid, Medicare, and other government-funded programs. Molina s health plans serve 1.8 million beneficiaries in ten states and Molina Medicaid Solutions provides business processing and information technology services to five states and one territory. Together, we serve over 4.3 million lowincome individuals and families nationwide. Molina Medicaid Solutions brings a fresh approach to the fiscal agent services market. We offer a modern, nimble methodology to the way we think and act while using technology to successfully achieve required outcomes. A healthcare information technology company for more than 30 years, we are driven to success using our extensive experience in both fee-for-service and managed care programs. Currently we offer our full fiscal agent services to the States of Idaho, Louisiana, Maine, New Jersey, West Virginia, and US Virgin Islands. Molina Offers You A next-generation MMIS solution that easily adapts to each state s vision and changes Health PAS Expert fiscal agent operations professionals leaders in the field with decades of Medicaid knowledge and experience Care management services that provide innovative support to ensure healthy outcomes Molina Pathways To help states achieve their mission of improving healthcare access and outcomes for Medicaid beneficiaries while demonstrating sound stewardship of financial resources, Molina provides flexible and adaptable solutions that combine excellence and innovation in technology, business operations, and care management services. We are a partner with modern information management tools and methodologies, a true understanding of healthcare and a culture focused on excellent client service. Molina has the technology, people, and values necessary to provide Healthcare IT Solutions Supporting Medicaid from Start to Future.

3 Health PAS: Designed to Do It All The Medicaid environment demands innovative and flexible solutions. Molina s Healthcare Payer Administration Solution, Health PAS, is the answer to this growing challenge. Health PAS combines excellence and innovation in technology, business operations, and system implementation to meet your Medicaid program needs. A Web-enabled, COTS-based solution, Health PAS has a centralized claims processing engine that integrates an array of optional components and shares data within a service-oriented, enterprise-wide architecture. Designed to Evolve with Federal Requirements Easily configurable to adapt to new federal standards and initiatives, including the Patient Protection and Affordable Care Act (ACA). Designed to meet CMS Seven Conditions and Standards. Allows Medicaid programs and State Children s Health Insurance Programs (SCHIP) to interface effectively and efficiently with new Health Insurance Exchanges. Consistent with both the Technical Standards and Architecture requirements presented in the CMS IT Guidance. Health PAS is the most complete healthcare management tool available in the marketplace today. Adaptable, customizable, flexible by choosing Health PAS, Medicaid programs are able to meet the demands and changes occurring in healthcare today and ensure they are making efficient investments in their healthcare technology. Built to last because it was built to change, Health PAS is the clear choice for meeting state Medicaid challenges Start to Future.

4 A healthcare/information technology company for more than 30 years, Molina develops, implements, and operates healthcare management solutions to support Medicaid programs and help states achieve their healthcare goals. Molina Medicaid Solutions: Because there is simply no substitute for comprehensive experience and proven success Molina offers experience in developing the underlying architecture, managing complex systems, transitioning from a legacy MMIS to a new MMIS, developing flexible and cost-saving system and processing innovations, and operating all services associated with claims processing, while serving as a fiscal agent. Health PAS for Your State s Full Spectrum of Fiscal Agent Operations Member eligibility and services Provider enrollment and services Benefit plan management Reference data management Claims and encounter processing Financial processing and reporting Quality management Electronic document interchange (EDI) Electronic health records (EHR) usage and exchange Patient care and program analytics State and federal reporting Our enterprise-wide depth and breadth of Medicaid Fiscal Agent experience spanning three decades provides our operations staff with a rich understanding of current and historical Medicaid policy and practices. In the complex and dynamic world of Medicaid enterprises, Molina understands the value of first-hand, relevant experience as an absolute necessity to ensure: Successful claims processing functions Accurate interpretation and configuration of program requirements Avoidance of unintended consequences through testing scenarios and protocols Complete documentation and deliverables Appropriate risk assessments and mitigation Realistic scheduling Professional project management

5 Molina Pathways: Managed Fee-for-Service Leveraging 30 Years of Managed Care Experience Pathways provides an integrated array of Care Management services that focuses on putting the Medicaid member at the center of care. Pathways integrates solutions, technology, processes, and qualified healthcare professionals to assess and deliver optimized Care Management to meet your needs. Our member-centered programs foster improved outcomes, alignment with your goals, and increased efficiencies in healthcare delivery and management. Medicaid Members the Focal Point of Care Management Molina s approach to care management ensures that health care services for Medicaid members are delivered in the most efficient and effective manner. Appropriate care management equips members to: Understand their health issues Recognize their power over their condition(s) Access needed services Become more independent Demonstrate self-advocacy Experience satisfaction with services Become an empowered care management partner The programs offered by Molina Pathways are: Care Access and Monitoring (Utilization Management): Ensures appropriate use of services and appropriate use of facilities via a single-streamlined process and centralized integrated technology. Confirms and reestablishes the members connection to their medical home. Disease and Care Management: Integrates case and disease management, including long-term care and behavioral health, to effectively support members. Confirms and reestablishes the members connection to their medical home. Health Care Transitions: Ensures appropriate transition to and from care levels. Confirms and reestablishes the members connection to their medical home. Nurse Advice Line: Our 24-hour nurse advice line helps members make wiser choices about their healthcare, which results in increased member satisfaction and significant cost savings for our state partners.

6 Molina Medicaid Solutions 4050 Innslake Dr. Suite 200 Glen Allen, VA (804) Connect with us: twitter.com/molinahealth facebook.com/molinahealth MMS0713