Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect. Quality improvement strategies

Transcription

1 Serving Hoosier Healthwise, Healthy Indiana Plan Quality improvement strategies

2 Learning objectives At the conclusion of this session, participants will be able to describe: Managed care products and eligible populations Provider bonus programs Member incentives to improve outcomes 2

3 Risk-based managed care delivery system Office of Medicaid Policy and Planning (OMPP) contracts with managed care entities (MCEs) to arrange, administer and pay for the deliveries of health care services to their members. The MCE is paid a capitated monthly premium for each Indiana Health Coverage Programs (IHCP) member enrolled with the plan. The MCE assumes financial risk for services rendered to its members. 3

4 Risk-based managed care delivery system (cont.) Hoosier Healthwise Healthy Indiana Plan (HIP) Hoosier Care Connect 4

5 HIP Plus offers an enriched benefit package HIP Plus gives members additional health care benefits: Dental care Vision services Adding chiropractic services beginning January 1, 2018 No copays for Plus members (unless they seek nonemergency care in the emergency department [ED]) 5

6 HIP Basic offers fewer benefits HIP Basic members get fewer health care benefits: No dental care No vision services Copays for services 6

7 Who runs the Medicaid program in Indiana? Centers for Medicare & Medicaid Services (CMS) Provides regulatory framework and oversight for all state Medicaid programs Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) policy and oversight of vendors 7

8 Who runs the Medicaid program in Indiana? (cont.) Indiana Health Coverage Programs (IHCP) Umbrella for state health care programs administered by OMPP Delegated entities Fiscal agent fee-for-service: DXC Four managed care entities (MCEs): Anthem Blue Cross and Blue Shield (Anthem) 8

9 State incentives for quality improvement HHW Adolescent Well-Care Visits Ambulatory Care outpatient visit/1000 Follow-Up After Hospitalization (FUH) within 7 days of behavioral health discharge Frequency of Prenatal Care (FPC) 81+ percent Postpartum Care (PPC) Well Child 0-15 months (W15) Well-Child Visit in the Third, Fourth, Fifth and Sixth Years of Life (W34) HIP Follow-Up After Hospitalization (FUH) within 7 days of behavioral health discharge Adult Access to Preventive Care (AAP) Ambulatory Care ER visit/1000 (inverted rate) HCC FUH within 30 days of discharge FUH within 7 days of discharge Adult Preventive Care (AAP) Ambulatory Care ER visit/1000 (inverted rate) 9

10 Provider incentive programs Negotiated Shared Savings PQIP BHQIP Provider Bonus Program Negotiated Shared Savings PQIP BHQIP BHFIP PAQCP OBQIP New for

11 Provider collaboration continuum 11 11

12 Mutual goals of a shared savings program Improve clinical quality results Improve medical cost management Improve provider operational efficiency Promote quality, safe and effective patient care Empowering providers to reach members for preventive services and chronic condition management Providing incentives and tools so providers reduce unnecessary utilization and costs Developing sustainable workflows and processes Improving the overall health care delivery system 12 12

13 2017 Provider Bonus Program Incentive attributed to performance of specific HEDIS measures and scaled to membership continues through Measurement Year 2017 (three installments) Hoosier Healthwise/ HHW/ Hoosier Care Connect/ HIP HCC Emergency Room HIP Visits (AMB-ER) Preventive Care/ Well-Care Visits (W15, W34, AWC & AMB-OP) Pregnancy measures for OB (FPC & PPC) Emergency Room Visits (AMB-ER) Preventive Care/ Well-Care Visits (AAP) Percentages of members seen within 90 days of enrollment 13 13

14 Provider Quality Incentive Program (PQIP) Eligibility 1,000 members assigned to group Begin in January of each year Quality measures Preventive care Chronic disease management diabetes, asthma Access Panel size contributes to scores 14 14

15 Behavioral Health Quality Incentive Program (BHQIP) Behavioral health providers and community mental health centers (CMHCs) Preventive care Preventive visits Unnecessary ER use Medication adherence Depression ADHD BH care Readmission prevention Outpatient follow-up 15 15

16 Provider Access and Quality Care Program (PAQCP) New for 2018 Eligibility Membership level > 250 members Availity adoption Open-panel status Appointment availability Quality measures Preventive visits Nonemergent ED use Follow-up after inpatient stay Access to care Nonemergent ER visits Inpatient utilization 16 16

17 Obstetric Quality Incentive Program (OBQIP) New for 2018 Overview Incentives to participating OB providers for improved quality of care Health plan chooses percentage of incentive to be offered Participation criteria Contracted and in good standing OBQIP Letter of Agreement Minimum of 10 attributed members Objectives Improved clinical quality indicators Improved member maternity outcomes Improved access to prenatal and postpartum care and education Improved efficient and appropriate utilization of benefits 2018 performance indicators Timeliness of first prenatal care visit Overall c-section rate Preterm birth rate Low birth weight rate Postpartum visit rate Other health plan-variable indicators 17 17

18 Obstetric Quality Incentive Program (OBQIP) (cont.) OBQIP Incentive Payments earned by OB providers will be made within six months after the end of the Performance Measurement Period. A Year-End OBQIP Performance Scorecard showing the OB provider s performance versus targets, incentive points earned and incentive payment percentage calculations will be generated five months after the end of the Performance Measurement Period to allow for claims runout and report production. Interim OBQIP reports will be generated periodically (no less than quarterly) and sent to the OB provider

19 PAQCP and OBQIP next steps Discuss program details with your quality staff. Sign and return Letter of Agreement to Anthem by December

20 Behavioral Health Facility Quality Incentive Program (BHFIP) New for 2018 Overview Designed for behavioral health inpatient facilities that serve our Medicaid members with behavioral health care needs: psychiatric hospitals, freestanding mental health facilities and acute care hospitals with psychiatric units Rewards both absolute performance and year-over-year improvement Year-end bonus driven by Performance Indicators Participation criteria Contracted and in good standing BHFIP Letter of Agreement The facility must have a total of at least 100 discharged members during the Performance Measurement Period Objectives Improved member outcomes Improved member continuum of care Improved clinical quality indicators Improved efficient and appropriate utilization of benefits 2016 performance indicators 30-day readmission Behavioral health spend per inpatient episode Seven day follow-up visit after mental health Inpatient discharge (FUH7) Thirty day follow-up visit after mental health inpatient discharge (FUH30) optional Multiple antipsychotic medications at discharge with appropriate justification overall rate (Joint Commission HBIPS-5) Assessment of violence risk, substance use disorder, trauma and patient strengths completed overall rate (Joint Commission HBIPS-1) 20 20

21 Member incentives 21 21

22 Member incentive program Engages members in their own self-care Rewards members for: Receiving preventive care Following up with care appropriately Adhering to chronic disease care Developing healthy habits (like smoking cessation and exercise) 22 22

23 Anthem Rewards New in 2017 Anthem will manage rewards through our claims systems. As members complete services, they are automatically entered for the reward. Members will earn rewards for completing preventive care. Members will receive reminders to complete preventive and follow-up care

24 Incentives for new members Members receive $10 to complete a Health Needs Screening (HNS) within 90 days of enrollment Members are given a variety of options to complete the HNS: Phone Online Walmart Pharmacy kiosk 24 24

25 Preventive visits Members from 3 to 85 years old can receive $20 for completing their annual wellness visit. Infants can receive an additional $50 for completing six visits by 15 months

26 Expectant mothers To encourage prenatal care and promote a healthy start for a new baby, we offer multiple incentives. Prenatal care Pregnant women who complete a prenatal visit in the first trimester receive $25. Postpartum care Mothers who complete a postpartum visit between 21 and 56 days after birth receive the equivalent of $50. Smoking cessation Pregnant women who engage and complete Indiana QuitLine sessions can earn the equivalent of up to $

27 Chronic diseases Diabetes vision screenings $20 will be awarded annually for the completion of eye exams for members with diabetes. HIV care Members engaged with Anthem Care Management who adhere to their medication regimen and reduce their viral load can receive up to $20 annually

28 Healthy habits Smoking cessation engagement Members who engage can earn up to $20 annually. Smoking cessation completion All members who smoke who engage and complete the Indiana QuitLine sessions can earn up $20 (one time)

29 Blue Ticket to Health Blue Ticket to Health educates families on the importance of seeing their primary medical provider (PMP) once a year, even when they are not feeling sick. This program is for Anthem members ages three years and older. Upon completion of an annual preventive visit and Anthem s receipt of the claim from the provider, the member is automatically entered into the Blue Ticket to Health incentive program

30 Blue Ticket to Health (cont.) Prizes Members are eligible for over 500 prizes including: Visits to Lucas Oil Stadium. Invitations to training camps. Tickets to the game. Signed jerseys

31 Value-added benefits Enhanced member benefits Hoosier Healthwise HIP Plus HIP Basic Home-delivered meals X X X Hoosier Care Connect Weight Watchers X X No-cost pregnancy tests X X X X High School Equivalency (HSE) test assistance Boys and Girls Club membership X X Healthy Families Program YMCA membership Personal exercise kit X X X X 31 31

32 Value-added benefits (cont.) Enhanced member benefits Retrofit Hoosier Healthwise HIP Plus HIP Basic Hoosier Care Connect Cellphone with 350 minutes X X X X Community Resource Link X X X X Youth and adult dental hygiene kits X X X Hypoallergenic bedding X X X Magazine subscriptions X X X X Rides X X X X Assistive devices Anthem ombudsman program X X X X X X 32 32

33 New team to assist members Community Health Workers: community-based support for members with chronic diseases who have unmet needs; offers education about benefits, community resources; helps members better manage their health Concierge Unit: call center connects members to services Health Educators: provide education to individuals and groups; topics range from healthy habits to chronic disease management Locate and Engage: communitybased support for members with serious behavioral needs who are most at risk for disengagement from the health care system; engages members using a person-centered approach to address key social determinants and health risk factors Member Liaison: helps find answers to questions members may have; serves as a mediator between members, their doctors and Anthem 33 33

34 Enhanced member outreach in 2017 Health education, tips and reminders and text messages improved and new in 2017 New technology of text campaigns added to promote preventive visits for various chronic diseases and annual preventive care such as diabetes screenings and adult preventive care Additional campaigns presented throughout the year with goals of enhancing member engagement 34 34

35 Pregnancy care New Baby, New Life Healthy pregnancy educational materials My Advocate Text for Baby Free health text messaging service Baby and Me Tobacco Free Smoking-cessation program Baby showers Events to educate pregnant women 35 35

36 Member support Community Resource Link: an innovative community resource tool on the web that helps members find and apply for community and social services throughout Indiana Transportation Services: transportation for doctor appointments, health education, WIC appointments and redetermination appointments New transportation vendor December 1, 2017 Anthem Concierge Unit: a service that helps members complete HNS, schedule appointments with their PMP, connect with community services and more Health education: free classes available at MyHealth@anthem.com

37 Special help Interpreter services Written materials: Available in 37 languages Telephonic help: Call Member Services Face-to-face/sign language: Call Member Services to request help Hearing or speech loss: Call

38 24/7 NurseLine The key is access: Helps members understand their medical condition and treatment Helps members connect with their doctor NurseLine can help connect members to an array of health care services The goal is to promote: Self care with information and education Support and care by PMP Care coordination services 24/7 NurseLine Hoosier Health Wise/Healthy Indiana Plan: Hoosier Care Connect:

39 Member POWER Account payment assistance An employer or nonprofit group, like a church or foundation, can pay some or all of the member s contribution. Payments can be made online at Just ask them to call Member Services at (TTY 711). For more information, members may visit our website at

40 Access and availability standards 40 40

41 Questions/comments is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. AINPEC October