A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
Agenda Introductions Power of Purpose Considerations for Care Coordination Model Considerations for inclusion in Request for Proposal (RFP) Implementation Timelines Closing Comments and Discussion 2
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 3
Introductions Blue Cross and Blue Shield of Oklahoma (BCBSOK) Introductions Ted Haynes, President, BCBSOK Dr. Joseph Cunningham, Divisional Senior Vice President, Health Care Delivery and Chief Medical Officer Julie Faulhaber, Vice President, Enterprise Medicaid Rick Kelly, Vice President, Network Operations David Goltz, Vice President, Government Programs Finance Esther Morales, Division Vice President, Quality Management Programs Pam Parker, BCBSOK Medicaid/Medicare Consultant 4
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
The Power of Purpose OUR PURPOSE To do everything in our power to stand with our members in sickness and in health BCBSOK is a Division of Health Care Service Corporation (HCSC) HCSC is the largest member-owned health plan in the nation Member-driven decisions: members are our owners, allowing decision-making with our members in mind INTEGRITY RESPECT COMMITMENT CARING 6
The Power of Purpose: Healthcare Delivery is Local 2014 Walk to End Alzheimer s LIFE Senior Services NewView Oklahoma received top Champions of Health award, 2014 7
The Power of Purpose: Strong Oklahoma Relationships Aged, Blind and Disabled (ABD) Care Coordination program will only be successful if built on strong relationships BCBSOK has been a member of the Oklahoma healthcare community for 75 years and has established, existing relationships with: Acute Care Providers and Hospitals Long-Term Care Providers Community Organizations Tribal Nations 8
The Power of Purpose: Medicaid Experience HCSC is committed to providing health care to all individuals in our communities, regardless of income level or health status Currently serving Medicaid communities TEXAS Children s Health Insurance Program (CHIP) and State of Texas Access Reform (STAR) NEW MEXICO Centennial Care and Dual Eligible Special Needs Plan (D-SNP) ILLINOIS Integrated Care Program (ICP), Family Health Plan (FHP), Medicare Medicaid Alignment Initiative (MMAI) (Dual Eligible) Experienced staff with the knowledge to assist in creation of a program that works for Oklahomans 9
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
Considerations for the Care Coordination Model The model should not be a single approach, but rather a blended model: Health Plan Community Collaborative Model (HPCCM) Health Plan model to partner with community organizations and services Integration of all benefits for the member: Long Term Services and Supports (LTSS) including Home and Community Based Services (HCBS) and other community support services Transportation HPCCM should coexist with current PACE programs Importance of Medicare integration Physical Health Behavioral Health Dental Vision Pharmacy 11
Considerations for the Care Coordination Model Alignment of model with existing OK initiatives: Comprehensive Primary Care Initiative (CPCi) Oklahoma Health Improvement Plan (OHIP) 2020 Plan Oklahoma State Innovation Model (OSIM) Provider payment structure: Value-based payment models tied to providers interest and capabilities Incentives to reward outcomes 12
Considerations for the RFP: Coverage and Availability of Model Network Development: Acute Care Physical and Behavioral Health Providers Hospitals LTSS Providers Community Supports Network recruitment, training and ongoing support Geographic Coverage Access Statewide include awards of urban and rural areas combined Full financial risk model for all services: Risk-based contract with OHCA Diagnosis- or claims-based risk-adjustment mechanism 13
Considerations for the RFP: Health Plan Community Collaborative Care Model Populations Served All ABD individuals eligible for SoonerCare Medicaid, as well as those dually eligible Members may choose to keep plan if change of setting occurs Care Model must be flexible to serve the unique needs of the population Include approach to assess members and stratify risk and service needs Holistic, person-centered approach to care Care Coordination across continuum led by the member, supported by interdisciplinary care team 14
Considerations for the RFP: Health Plan Community Collaborative Care Model (Cont d.) Quality Include quality and health outcome requirements and align both with key SoonerCare goals that target this population Care Model requires annual audited Healthcare Effectiveness Data and Information Sets (HEDIS), annual Consumer Assessment of Health Plan Survey (CAHPS) results and accreditation within 3 years from nationally recognized agency Collaborative Performance Improvement Projects (PIPs) to improve outcomes. 15
Implementation Strategy Implementation components (may occur concurrently) Contract Start Up Phase Implementation Readiness Operational Start Date/ Member Transition Post Transition Implementation of member enrollment OHCA administers implementation Enrollees should have the option to choose the Health Plan Community Collaborative or PACE Models Suggest a 12-month or calendar year enrollment period to ensure continuity of care and cost efficiencies Propose a phased enrollment 16
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
Questions Ted Haynes, President, BCBSOK Dr. Joseph Cunningham, Division Senior Vice President, Health Care Delivery and Chief Medical Officer Julie Faulhaber, Vice President, Enterprise Medicaid Rick Kelly, Vice President, Network Operations David Goltz, Vice President, Government Programs Finance Esther Morales, Division Vice President, Quality Management Programs Pam Parker, BCBSOK Medicaid/Medicare Consultant 18