Improving Member Health and Quality of Life Rural Health Symposium - PowerPoint PPT Presentation

Improving Member Health and Quality of Life Rural Health Symposium June 19, 2018 Presented by Rafielle Freeman and Cheri Moreland BlueCare Tennessee is an Independent Licensee of BlueCross BlueShield 1 Association. This document has been classified as Confidential and Proprietary.

BlueCare Facts Founded in 1993 as one of TennCare’s first Managed Care Organizations (MCOs) Created as a stand-alone, for-profit subsidiary; with a separate HMO license Employs over 900 employees, head-quartered in Chattanooga, TN, with 5 regional offices Provide healthcare services to ~ 600,000 members NCQA Accredited Hold multiple contracts with the State of Tennessee 2

BlueCare Tennessee Products and Populations BlueCare CHOICES/ Plus Employment & TennCare BlueCare Core CoverKids Dual Special Community Select Risk Needs Plan First (ECF) (DSNP) CHOICES Children’s Health Traditional Medicaid Medicaid long-term Statewide program Program for program providing services and supports for some of our most individuals who are Insurance Program physical and program providing vulnerable dually eligible for (CHIP) providing full behavioral health nursing facility and populations such as Medicare and health coverage for services to low-income home-based care. SSI and children in Medicaid. Risk-based eligible children age children, pregnant Effective July 1, state custody. contract effective 18 and under, as well women and disabled 2016, ECF promotes Administrative January 1, 2014. as pregnant women, individuals. and supports Services Only (ASO) Supplemental whose household – based contract. Risk-based contracts integrated, benefits include income exceeds for East, Middle, and competitive dental and vision . traditional Medicaid West Tennessee employment and limits. regions. independent living skills for individuals with intellectual and developmental disabilities (IDD) 496,295 11,462 35,710 15,562 71,039 3

BlueCare Tennessee Membership as of 5/11/18 4

BlueCare Tennessee Mission 5

Member Outreach Member Outreach is an activity of providing services to our populations who might not otherwise have access to those services. 6

Wh What is is di differ eren ent t about t Med edic icaid id manage ged d care? To improve population health “it’s the housing, it’s the lack of access to food, it’s the broken families, it’s all that messy stuff. It’s a complex story so it can’t have a medical fix to make it work rk .” Dr. David B. Nash Dean of the Jefferson School of Population Health 7

Educate & Encourage our Members To Improve Outcomes 8

TennCare Kids EPSDT TennCare Kids is a full program of checkups and health care services for children from birth through age 20 who have TennCare. These services make sure that babies, children, teens, and young adults receive the health care they need. 9

TennCare Kid ids – EPS PSDT Membership and Goal BlueCare Tennessee provides health plans to more than 353,000 members under the age of 21. Our goal is to assure that children get the health care they need when they need it • The right care, to the right child, at the right time, in the right setting Address health problems before they become advanced and treatment is more difficult and costly This can be accomplished with your help through their EPSDT Screenings 10

TennCare Kid ids – EPS PSDT EPSDT Defined EP EPSDT Defini initi tion: on: The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. Early – Assessing and identifying problems early Peri riodic dic - Checking children's health at periodic, age-appropriate intervals Screen enin ing - Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems Diagn gnosis osis - Performing diagnostic tests to follow up when a risk is identified Treatme tment nt - Control, correct or reduce health problems found 11

TennCare Kid ids – EPS PSDT 2015-2017 CMS-416 MCO Averages 12

TennCare Kid ids – EPS PSDT CMS-416 Yearly Rate Comparisons – Middle Middle Middle County 2016 2017 County 2016 2017 Bedford 66% 78% Marshall 71% 83% Maury 70% 77% Cannon 58% 62% Montgomery 69% 78% Cheatham 72% 78% Moore 69% 77% Clay 61% 63% Overton 59% 70% Coffee 67% 76% Perry 53% 56% Cumberland 79% 83% Pickett 70% 78% Davidson 77% 82% Putnam 80% 86% DeKalb 57% 63% Robertson 74% 82% Dickson 62% 66% Rutherford 67% 77% Fentress 60% 68% Smith 63% 66% Giles 68% 70% Stewart 57% 64% Hickman 61% 72% Sumner 63% 71% Houston 62% 65% Trousdale 64% 71% Humphreys 64% 72% Van Buren 68% 65% Jackson 72% 75% Warren 60% 65% Lawrence 69% 81% Wayne 67% 75% Increased = 38 Lewis 64% 69% White 77% 82% Decreased = 1 Lincoln 56% 62% Williamson 66% 71% No Change = 0 Macon 64% 73% Wilson 67% 75% 13

TennCare Kid ids – EPS PSDT CMS-416 Yearly Rate Comparisons – West West County 2016 2017 Benton 76% 84% Carroll 72% 85% Chester 57% 61% Crockett 69% 73% Decatur 55% 63% Dyer 83% 86% Fayette 66% 73% Gibson 66% 68% Hardeman 56% 63% Hardin 53% 56% Haywood 52% 62% Henderson 59% 65% Henry 68% 71% Lake 64% 73% Lauderdale 59% 70% Madison 60% 61% McNairy 52% 57% Obion 64% 76% Increased = 20 Shelby 68% 71% Decreased = 0 Tipton 64% 64% No Change = 1 Weakley 68% 74% 14

TennCare Kid ids – EPS PSDT CMS-416 Yearly Rate Comparisons – East East East County 2016 2017 County 2016 2017 Johnson 65% 69% Anderson 62% 65% Knox 64% 68% Bledsoe 64% 65% Loudon 70% 77% Blount 66% 70% Marion 58% 58% Bradley 61% 63% McMinn 74% 76% Campbell 74% 76% Meigs 77% 75% Carter 70% 77% Monroe 69% 76% Claiborne 59% 64% Morgan 64% 65% Cocke 78% 85% Polk 58% 57% Franklin 65% 70% Rhea 64% 69% Grainger 65% 70% Roane 74% 68% Greene 64% 76% Scott 62% 62% Grundy 58% 63% Sequatchie 57% 65% Hamblen 76% 80% Sevier 69% 78% Hamilton 62% 66% Sullivan 65% 70% Increased = 30 Hancock 75% 84% Unicoi 81% 84% Decreased = 3 Hawkins 64% 75% Union 68% 72% No Change = 2 Jefferson 72% 76% Washington 74% 81% 15

Community Care Partners Sylvia Stamper Alisa Johnson Jasmine Dary Community Care Partner (CCP) Community Care Partner (CCP) Community Care Partner (CCP) Office: 423-535-8172 Office: 423-854-6048 Office: 423-535-8108 Cell: 423-255-6875 Cell: 423-413-5557 Cell: 615-393-1386 Email: Sylvia_Stamper@BCBST.com Email: Alisa_Johnson@BCBST.com Email: Jasmine_Daryl@BCBST.com Shanae Carrawell Shenece Craddock Community Care Partner (CCP) Community Care Partner (CCP) Office: 901-544-2302 Office: 423-535-7427 Cell: 901-302-0820 Cell: 423-463-2984 Email: Kiawanna_Carrawell@BCBST.com Email: Shenece_Craddock@BCBST.com 16

Strategies to Promote Event Attendance Telephone Calls Postcards Website Postings Facebook/Instagram Flyers Incentives 17

Fitness Events 18

Advisory Panels & Workshops 19

Meet Members Where They Live Community & Health Equity Advisory Panels Regional Priority: Regional Priority: TBD Opioid Use Disorder Purpose: The role of the BlueCare Tennessee’s Community and Regional Priority: Regional Priority: Health Equity Panel is Social Service Exchange EPSDT to drive movement toward health equity + BlueCare team has assembled a set of Community and Health Equity Advisory in and between Panels in four regions of Tennessee: Upper East, Lower East, Middle and West. communities across + These groups include BlueCross and BlueCare leaders, along with physicians and the state. representatives from community agencies in those regions + BlueCare and its partners are tackling different health needs in different ways, because the populations in each part of Tennessee face unique challenges + BlueCare is taking a collaborative approach to better understand how those challenges are playing out in real life for the residents of those regions 20

Meet Members Where They Live CHOICES Advisory Panels Middle Region: CHOICES Advisory Board Purpose: The role of the BlueCare Tennessee’s CHOICES Advisory Panel is to create West Region: East Region: a forum where members, CHOICES Advisory Board CHOICES Advisory Board member representatives, advocates and providers offer input and + The CHOICES Advisory Group provides input into BC/TCS’ planning and delivery recommendations of long-term support services, CHOICES Quality Management/Quality regarding BlueCare Tennessee’s program, Improvement activities, program monitoring and evaluation, as well as member, policies and procedures. family and provider education + BC/TCS provides orientation and ongoing training for Advisory Group members in order for them to have sufficient information and understanding of the CHOICES program to fulfill their responsibilities + Additional Panels include ECF CHOICES Advisory Panel and Behavioral Health Advisory Committee 21