MMP and California The future of CalMediConnect. Deborah Miller Plan President Molina Healthcare of California

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1 MMP and California The future of CalMediConnect Deborah Miller Plan President Molina Healthcare of California

2 MHC footprint Syum today 2

3 Overview: What Is Working? Many more options now exist on the care continuum Increased CBO collaboration with Health Plan Care Coordination Provider recognition of Value Added from Care Coordination by Plans Care Coordination delivered in the member s community Expanding workforce of experienced care coordinators Hospitals more receptive to on-site Transitions of Care by Plan Barriers to addressing social determinants of health are decreasing California Data shows members are satisfied with CalMediConnect 3

4 The Continuum of Care Continuum of Coordinated Care 4

5 CBO Collaboration with Plans is Increasing CBO and Plans are now sharing key information for purpose of: Locating Unable to Contact Members Completing Health Risk Assessment Integrated Care Plans Helping member access care in right setting, timely referrals to care and follow-up CBO s Include IHSS County of Behavioral Health and Substance Use Treatment programs CBAS MSSP Nursing Homes Hospitals 5

6 Recognition of Value Added Progress is slow in recognizing Value added by CalMediConnect and care coordination. Providers must be educated on: The value of Care Coordination and CalMediConnect Reasons to participate in improving quality measures and in reporting quality data The value of participating in integrated care planning How to encourage patients to enroll in CalMediConnect How to prevent member disenrollment in CalMediConnect How the plan supports member s health goals and choices Plan promotes acceptance of physician plan of care The huge financial and time investment the plans have made in care coordination and how it benefits the physician 6

7 Care Coordination Delivered in Community In member s home In shelters Recuperative care centers Hospitals Nursing homes Out patient clinics, PCP offices Where ever the member is comfortable 7

8 Expanding Care Coordination Workforce Molina does not outsource Care Coordination Molina care coordination staff live and work in the community they serve LA, Riverside, San Bernardino, San Diego Targeted recruitment for bilingual and bicultural staff based on make up of Molina membership in community Staff know the services available in the community Staff understand social determinants of health particular to community Pathways Behavioral Health Program: staff engage most complex members to promote BH follow-up care 8

9 Hospitals and Transitions of Care Hospitals are now allowing Molina on site to deliver transitions of care services and to coordinate after care Molina has staff in its top 20 hospitals in terms of number of member served and cost EDSU emergency department support unit created to direct members with non-emergent care needs to a more appropriate level of care Staff available 24/7/365 to assure access to services-includes SNF, DME, next day clinic appointments Greater shared access to Electronic Medical Records can streamline key processes and reduce administrative costs associated with CMC 9

10 Barriers to Addressing Social Determinants of Care Barriers remain but solutions are gaining acceptance Care Plan Option Services: Accessibility ramps, food security, respite care. Recuperative Care: Temporary care post hospital to allow time to solidify recovery. Affordable Assisted Housing: For those with mental illness and multiple medical comorbidities remain a huge barrier to health, calls for the pooling of resources to assure transitions to home. 10

11 Consumer Experience Is Positive This message must be shared with: Potential consumers need clear materials and easy enrollment processes. Physicians-engage providers in preventing disenrollment by educating them about what we do, benefits to members and providers Advocates General public 11

12 The Continuum of Care Continues to Grow What has been gained with CalMediConnect over the last few years represents a huge cultural shift toward a member centric integrated approach to care coordination and cost containment. Consumers have more choices, a role in care planning, greater access to a range of resources and trained subject matter experts available to assist them in achieving their personal health goals. Whole Person Care and Health Homes equal important additions to the continuum of care representing new formats that speak to the unique needs of segments of our population. CalMediConnect must remain as the essential foundation of coordinated care in California 12