MassHealth Primary Care Clinician (PCC) Plan's Integrated Care Management Program
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1 MassHealth Primary Care Clinician (PCC) Plan's Integrated Care Management Program Presented by: Massachusetts Behavioral Health Partnership (MBHP) September 17 & 18, 2013
2 MBHP OVERVIEW Established in 1996, MassHealth Enrollees who are enrolled in the PCC Plan receive their behavioral health services through MBHP (360,000 members) Clinical/Utilization Management Network Management (5 Regional Offices) Administrative/ Claims Processing Quality Improvement/ Management 1
3 SERVICES FOR MEMBERS Community Support Program Utilization Management Medical, Mental Health, Substance Use Disorder care management PCC PLAN MEMBER Member Engagement 24/7 Nurse Advice Line Peer Bridge Program 2
4 INTEGRATED CARE MANAGEMENT PROGRAM (ICMP) Providing added support and services for YOUR patients as they transition back to the community with medical and behavioral health needs 3
5 GOAL OF ICMP The ICMP is designed to support medical and behavioral health care providers by providing integrated medical and behavioral health care management and care coordination services to Members. You can link patients to ICMP prior to their discharge. You can request an ICMP visit to your facility. 4
6 ABOUT ICMP Comprehensive physical and behavioral health care management and care coordination Partnership with McKesson Health Solutions Behavioral health clinicians and registered nurses with medical and behavioral health expertise who are based in 5 regional locations Voluntary program 5
7 HOW WILL ICMP ASSIST PCC PLAN PATIENTS? MEMBER ENGAGEMENT CENTER LINKAGES WITH COMMUNITY-BASED SUPPORTS AND RESOURCES NURSE ADVICE LINE FACE-TO-FACE VISITS INITIAL ASSESSMENT, EDUCATION, ADDRESS BARRIERS, & GOAL SETTING FACILITATE COMMUNICATION AMONG PROVIDERS 6
8 CASE EXAMPLE Prescriptions: Unable to get prescription filled Prosthesis & Wheelchair Durable Medical: Prosthesis does not fit. Wheelchair broken. Medical Female (mid 50 s) Transport Accessible Apartment Medical: Diabetes, PVD, Neuropathy, Obesity, leg amputated 7 years ago. Community: Apartment not accessible. Lack of transportation and ability to move around. 7
9 CORE CONDITIONS Asthma MEDICAL Diabetes Coronary Artery Disease COPD Heart Failure BEHAVIORAL Depression Bipolar Schizophrenia NEW CONDITIONS FALL 2013!! Anxiety ADHD Developmental Disability Substance Abuse: Alcohol, Opioid, Cocaine Frequent Emergency Department Utilization End Stage Renal/Chronic Kidney Disease 8
10 RISK IDENTIFICATION & STRATIFICATION Members identified through a predictive modeling application using pharmacy and claims data Physical Health Claims Pharmacy Claims Behavioral Health Claims Risk Stratification Level for each Member 9
11 Tier 3 Direct Referrals to ICMP Referrals to ICMP are made primarily by: Medical providers Behavioral health providers State Departments (DMH, DCF, DDS, etc.) 300+ Members in ICMP currently have been directly referred 10
12 Referring patients to ICMP is easy! 11
13 WHO SHOULD I REFER? PCC Plan Patients who: Are awaiting discharge from your facility Are frequent ED utilizers Have chronic medical or behavioral health conditions Have a need for education about their condition(s) for improved health outcomes 12
14 HOW DO I REFER? No Wrong Door! Online: Phone: ext Fax:
15 CONTACTS Kate Flanagan-Helmes, AVP Integrated Care Management Program Phone:
16 REGIONAL CARE MANAGEMENT SUPERVISORS Metro Boston Sharon Singer Phone: Northeast: Danvers Michelle Silkes Phone: Southeast: Bridgewater Melissa Crownover Phone: Central: Worcester Kevin Patterson Phone: Western: Holyoke Jennifer Genovese Phone:
17 Thank you!
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