Engaging Consumers in Care

Transcription

1 Engaging Consumers in Care Cal MediConnect Providers Summit January 21, 2015 Moderator: Carolyn Ingram, Senior Vice President, CHCS

2 Reaching Medicare-Medicaid Enrollees Medicare-Medicaid enrollees can be hard to reach due to significant health and social service needs and unstable housing arrangements Traditional outreach methods don t always work: mailings, billboards, bus signage, and paid search services Plans and providers face challenges maintaining upto-date contact information and reaching and serving members in a timely way SOURCE: S. Barth and B. Ensslin. Contacting Hard-to-Locate Medicare and Medicaid Members: Tips for Health Plans. Center for Health Care Strategies, December Available at: 157

3 Tips for Contacting Hard-to-Locate Members 1. Identify current providers from data 2. Maximize community partnerships 3. Send staff into the community 4. Use outreach staff 5. Target calls early in the month 6. Engage a broad group of partners 7. Establish electronic flag mechanisms 8. Assign specific staff 9. Knock on doors SOURCE: S. Barth and B. Ensslin. Contacting Hard-to-Locate Medicare and Medicaid Members: Tips for Health Plans. Center for Health Care Strategies, December Available at: 158

4 Cal MediConnect Engaging Consumers in Care Cal MediConnnect Ombudsman for LA County Neighborhood Legal Services of Los Angeles 159

5 The Role of the Ombudsman Neighborhood Legal Services of Los Angeles (NLSLA), the Cal MediConnect Ombudsman for Los Angeles County, works to ensure that beneficiaries can access all needed medical care. This includes consumer education and direct consumer assistance with continuity of care requests for Medicare and Medi-Cal covered services. Neighborhood Legal Services of Los Angeles 160

6 Who are the new plan members Dual eligibles are among our most vulnerable community members and face many challenges to accessing care: Elderly and frail individuals Complex medical conditions Cognitive impairment Mental health issues Language barriers Low literacy Low income with limited resources Neighborhood Legal Services of Los Angeles 161

7 New Member Care Challenges Unfamiliar with concept of managed care Unfamiliar with using PCP to access care Not readily reached by telephone Confused by plan calls- who is this calling, and why are they calling me Unable to access services and service delivery problems- no idea what to do Neighborhood Legal Services of Los Angeles 162

8 New Member Challenges Passive enrollment surprise Elected to enroll but didn t really know what this meant or how to use managed care benefits Fear and distrust Confused and fragile so unexpected delays and problems are overwhelming Inflexible- reluctant to make changes Neighborhood Legal Services of Los Angeles 163

9 Case Example Sandra Chose to enroll in a Cal MediConnect (CMC) plan 50 years old: quadriplegic Needs incontinence supplies Existing prescription not accepted Unable to get appointment with new PCP to get prescription written Unable to get plan care coordination Paid cash for supplies Neighborhood Legal Services of Los Angeles 164

10 Case Example Larry 91 yrs old, lives alone Legally blind Demonstrating confusion and cognitive decline Rarely answers telephone as he moves slowly, limited vision, poor memory Needs IHSS Will probably be passively enrolled A good candidate for CMC Neighborhood Legal Services of Los Angeles 165

11 What Can Providers Do to Help Their Patients? To realize the promise of CCI, plan providers, will need to recognize new members limitations Providers will need to develop approaches that over come the individuals limitations and fears Care coordination must be a priority for serving this fragile population Pre-emptive planning versus problem solving Neighborhood Legal Services of Los Angeles 166

12 Toni Vargas, Staff Attorney (800) Neighborhood Legal Services of Los Angeles 167

13 January 21, 2014 Engaging Consumers in Care Jennifer Rasmussen, AVP Case Management MOLINA HEALTHCARE OF CALIFORNIA

14 Molina s Approach - Central Teams 169 Conduct Welcome calls introduce plan, managed care basics, answer questions Initiate Health Risk Assessment - Outreach to non-ltss low risk members with quick hand off process to regional teams for in-person assessment or to research those not reached 2012 Molina Healthcare, Inc.

15 Molina s Approach - Regional Teams 170 Molina staff who live and work in the MMP Counties Direct assignment of ALL high risk and low risk LTSS members Poised to respond quickly many in-person meetings done same or next day Know the community s geography, cultures, languages, providers, resources/services Languages spoken by Molina s staff: Spanish, Tagalog, Vietnamese, Russian, Armenian, French, Farsi, Korean, Chinese, Arabic Familiar with local SNFs, senior and low-income housing, CBAS centers, etc Molina Healthcare, Inc.

16 Challenges - Finding the members 171 Multiple enrollment files, data on file with state not current or accurate (disconnect, incorrect, incomplete) Difficult to determine accuracy No answer, no voic , no call back Denial, screening Borrowed contact info Language preference not known Hang up Research invalid info - Use historical claim data to identify past providers call them for alternate contact info 2012 Molina Healthcare, Inc.

17 Success with Community Connectors 172 Success in Molina s New Mexico health plan - community health worker model Adopted in May now 54 staff support all products Non-clinical staff approachable and talk healthcare without the lingo, trained with motivational interviewing techniques 54 field-based staff, live in and reflect the communities we serve, most bi-cultural, bilingual Call from non Molina-identified phone numbers Visit address(es) on file, follow leads to other addresses, community centers, shelters, etc. Address member concerns, questions first, Conduct assessments in the moment 2012 Molina Healthcare, Inc.

18 Engaging the members 173 Don t know enrolled in plan Time spent on basic Cal MediConnect education Answer questions Mitigate confusion or anger Provide Health Care Options info if requesting to disenroll Dispelling myths and misinformation Getting to the assessment Explain what it is Offer in-person visit, alternatives if needed Listening Use motivational interviewing Address concerns first, e.g. continuity of care Mission driven, balance of reward, service 2012 Molina Healthcare, Inc.

19 Engagement Barriers 174 Some people don t want to be found Out of the service area, out of the country Behavioral health issues prevalent Transience, homelessness Limited minutes on cell phone Shared phones among family members Member uses this address Declines 2012 Molina Healthcare, Inc.

20 Engaging Consumers in Care: A Cal MediConnect Provider Group s Perspective Daniel Frank Regal Medical Group Lakeside Community Healthcare Affiliated Doctors of Orange County

21 MA Pioneer ACO Duals Commercial 0 0 Exchange MediCal Finance Medical Management Network Management Decision Support HCC/STAR Eligibility Claims Inpatient Prior Authorization Campus High Risk Provider Network Provider Engagement Member Engagement Common IT Platform

22 Life of a Dually Eligible Regal Enrollee Welcome Packet Welcome Call

23 Life of a Dually Eligible Regal Enrollee (Cont.) New Member Visits: One-on-one at home/public setting Group meetings Inpatient Visits: Facility based Post-discharge Post-ER discharge Accompany Members to: Medical appointments Post-discharge clinic visits

24 Life of a Dually Eligible Regal Enrollee (Cont.) Care Management Daily Rounds Individual Care Plans Interdisciplinary Care Teams Medical Director Case Manager Member Behavioral Health Specialist Continuity of Care 12 month allowance Expedited turnaround time Custodial Specialist Social Worker Pharmacist

25 Keys to Member Engagement 1. Face-to-face contact 2. Culture/language match 3. Being a friend

26 Challenges & Opportunities 1. Difficulty in tracking down members Missing accurate contact information Transient population 2. Lack of member understanding of: Managed care Cal MediConnect Demonstration 3. Opportunities for: Plans and groups to coordinate on-boarding strategies Government/plans to provide more member data to groups so the latter can better prepare for engagement/care coordination

27 Brenda Premo Director Harris Family Center for Disability and Health Policy Western University 182

28 Questions and Discussion 183