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
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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
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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
Traditional Medicaid program providing physical and behavioral health services to low-income children, pregnant women and disabled individuals. Risk-based contracts for East, Middle, and West Tennessee regions.
496,295
Medicaid long-term services and supports program providing nursing facility and home-based care. Effective July 1, 2016, ECF promotes and supports integrated, competitive employment and independent living skills for individuals with intellectual and developmental disabilities (IDD)
11,462
Statewide program for some of our most vulnerable populations such as SSI and children in state custody. Administrative Services Only (ASO) – based contract.
35,710
Program for individuals who are dually eligible for Medicare and
contract effective January 1, 2014. Supplemental benefits include dental and vision.
15,562
Children’s Health Insurance Program (CHIP) providing full health coverage for eligible children age 18 and under, as well as pregnant women, whose household income exceeds traditional Medicaid limits.
71,039
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BlueCare Tennessee Products and Populations
CHOICES/ Employment & Community First (ECF) CHOICES TennCare Select BlueCare Plus Dual Special Needs Plan (DSNP) CoverKids BlueCare Core Risk
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BlueCare Tennessee Membership
as of 5/11/18
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BlueCare Tennessee Mission
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Member Outreach is an activity of providing services to our populations who might not otherwise have access to those services.
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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
make it work rk.”
Dean of the Jefferson School of Population Health
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Educate & Encourage our Members
To Improve Outcomes
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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.
TennCare Kid ids – EPS PSDT
Membership and Goal
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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 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
TennCare Kid ids – EPS PSDT
EPSDT Defined
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EP EPSDT Defini initi tion:
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
Treatme tment nt - Control, correct or reduce health problems found
TennCare Kid ids – EPS PSDT
2015-2017 CMS-416 MCO Averages
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TennCare Kid ids – EPS PSDT
CMS-416 Yearly Rate Comparisons –Middle
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Middle
County 2016 2017 Bedford 66% 78% Cannon 58% 62% Cheatham 72% 78% Clay 61% 63% Coffee 67% 76% Cumberland 79% 83% Davidson 77% 82% DeKalb 57% 63% Dickson 62% 66% Fentress 60% 68% Giles 68% 70% Hickman 61% 72% Houston 62% 65% Humphreys 64% 72% Jackson 72% 75% Lawrence 69% 81% Lewis 64% 69% Lincoln 56% 62% Macon 64% 73%
Middle
County 2016 2017 Marshall 71% 83% Maury 70% 77% Montgomery 69% 78% Moore 69% 77% Overton 59% 70% Perry 53% 56% Pickett 70% 78% Putnam 80% 86% Robertson 74% 82% Rutherford 67% 77% Smith 63% 66% Stewart 57% 64% Sumner 63% 71% Trousdale 64% 71% Van Buren 68% 65% Warren 60% 65% Wayne 67% 75% White 77% 82% Williamson 66% 71% Wilson 67% 75%
Increased = 38 Decreased = 1 No Change = 0
TennCare Kid ids – EPS PSDT
CMS-416 Yearly Rate Comparisons –West
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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% Shelby 68% 71% Tipton 64% 64% Weakley 68% 74%
Increased = 20 Decreased = 0 No Change = 1
TennCare Kid ids – EPS PSDT
CMS-416 Yearly Rate Comparisons –East
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East
County 2016 2017 Anderson 62% 65% Bledsoe 64% 65% Blount 66% 70% Bradley 61% 63% Campbell 74% 76% Carter 70% 77% Claiborne 59% 64% Cocke 78% 85% Franklin 65% 70% Grainger 65% 70% Greene 64% 76% Grundy 58% 63% Hamblen 76% 80% Hamilton 62% 66% Hancock 75% 84% Hawkins 64% 75% Jefferson 72% 76%
East
County 2016 2017 Johnson 65% 69% Knox 64% 68% Loudon 70% 77% Marion 58% 58% McMinn 74% 76% Meigs 77% 75% Monroe 69% 76% Morgan 64% 65% Polk 58% 57% Rhea 64% 69% Roane 74% 68% Scott 62% 62% Sequatchie 57% 65% Sevier 69% 78% Sullivan 65% 70% Unicoi 81% 84% Union 68% 72% Washington 74% 81%
Increased = 30 Decreased = 3 No Change = 2
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Community Care Partners
Alisa Johnson
Community Care Partner (CCP) Office: 423-854-6048 Cell: 423-413-5557 Email: Alisa_Johnson@BCBST.com
Sylvia Stamper
Community Care Partner (CCP) Office: 423-535-8172 Cell: 423-255-6875 Email: Sylvia_Stamper@BCBST.com
Jasmine Dary
Community Care Partner (CCP) Office: 423-535-8108 Cell: 615-393-1386 Email: Jasmine_Daryl@BCBST.com
Shanae Carrawell
Community Care Partner (CCP) Office: 901-544-2302 Cell: 901-302-0820 Email: Kiawanna_Carrawell@BCBST.com
Shenece Craddock
Community Care Partner (CCP) Office: 423-535-7427 Cell: 423-463-2984 Email: Shenece_Craddock@BCBST.com
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Strategies to Promote Event Attendance
Telephone Calls Postcards Website Postings Facebook/Instagram Flyers Incentives
Fitness Events
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Meet Members Where They Live
Community & Health Equity Advisory Panels
Regional Priority: Opioid Use Disorder Regional Priority: EPSDT Regional Priority: TBD Regional Priority: Social Service Exchange
Purpose:
The role of the BlueCare Tennessee’s Community and Health Equity Panel is to drive movement toward health equity in and between communities across the state. + BlueCare team has assembled a set of Community and Health Equity Advisory Panels in four regions of Tennessee: Upper East, Lower East, Middle and West. + These groups include BlueCross and BlueCare leaders, along with physicians and 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
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Meet Members Where They Live
CHOICES Advisory Panels
East Region: CHOICES Advisory Board Middle Region: CHOICES Advisory Board West Region: CHOICES Advisory Board
Purpose:
The role of the BlueCare Tennessee’s CHOICES Advisory Panel is to create a forum where members, member representatives, advocates and providers
recommendations regarding BlueCare Tennessee’s program, policies and procedures.
+ The CHOICES Advisory Group provides input into BC/TCS’ planning and delivery
Improvement activities, program monitoring and evaluation, as well as member, 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
Resource Parent Education
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Insurance should be the least
should never wonder about which path to go in terms of the child’s healthcare. We want to provide support. Strengthen Resource Parent awareness of our programs and services Offer curriculum for inclusion in the Resource Parent Training Program Improve the Resource Parent Experience regarding Access to Care Promote Healthy Lifestyles and Explore Opportunities to Address Gaps in Care
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Community Partnership Engagement
Goals and Rational
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Goal
Our Community Engagement Strategy focuses on building relationships with community agencies, stakeholders, civic organizations and interest groups to work side-by-side as long- term partners—building a coalition of support for BC/TCS programs, initiatives, policies, and services—with the end goal of improving the quality and efficiency of care for BlueCare members statewide and making the community a better place to live.
Rational
diverse resources, programs, services and activities to improve the quality of members lives.
accessing and sharing resources, population assessments, to community consultation, community outreach events, referral services and in most instances, active participation in decision-making processes.
support our operational goals including NCQA, EPSDT, and HEDIS /CAHPS, allowing them to see multiple sides and increasing the likelihood that initiatives and/or solutions will be widely accepted.
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Provider Tools
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Provider Administration Manual Monthly BlueAlert Newsletter Articles Quality Newsletters Clinical Practice Guidelines Website Resources including Billing Guidelines and Toolkits Collaboration with the Tennessee Chapter of the American Academy of Pediatrics, Tennessee Primary Care Association and Tennessee Hospital Association Annual All Blues Workshops Annual Tennessee Medical Association Workshops Annual Vaccines for Children Workshop Various Provider Conferences
Provider Tools
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Community Mental Health Center Initiatives Medical Record Audits Behavioral Health Resources
Other techniques and tools
Enhanced Training BEHIP
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BEHIP Behaviorally Effective Healthcare In Pediatrics Collaborative training program between BlueCare and TNAAP to educate pediatric PCPs to
emotional, behavioral, and substance abuse challenges
Enhanced Training BEHIP
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Available online Free and will earn up to 5.25 AMA PRA Category 1 credit(s) To access the online training modules, visit http://www.tnapp.org/behip and look for the online training modules link Provide pediatric healthcare provider with tools and strategies to screen for, access and manage patients with common behavioral health concerns Modules range from 30 minutes to 1 hour, covering the following topics:
Provider Quality Engagement Strategy
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Achieving successful patient outcomes is directly impacted by Provider Engagement. To accomplish this evolving focus on quality, Health Plans across the nation have evolved their quality improvement portfolio by partnering with primary care providers through Pay for Quality programs. Quality-based purchasing strategies aim to better coordinate a variety of quality improvement efforts toward a shared set of priorities that focus on core
Successful quality-based program implementation and thus effective provider engagement includes identification of performance indicators which are:
Resources: HealthChoice and Acute Care Administration Division of HealthChoice Management and Quality Assurance (2012). Medicaid Managed Care Organization Value-Based Purchasing Activities Report. Retrieved from https://mmcp.dhmh.maryland.gov. Optum (2015). Provider engagement has a major impact on quality, costs and outcomes. Retrieved from http://www.optum.com.
Provider Quality Engagement Strategy
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The essential elements to provider engagement with the goal to improve quality and member health outcomes include the following: Increased adoption of gap closure activities
close applicable member gaps in care. Said systems offer providers near-time access into patient profiles and most importantly into integral gaps in care reports. Such essential patient information helps providers to ascertain a much more holistic view of their patients’ health status and provide a greater impact on overall patient health outcomes.
Use of data-driven best practices
more targeted interventions for patients and more efficient use of a provider’s time. It also decreases unnecessary tests and treatments, increasing provider and health plan financial performance.
Improved use of decision-support tools and thus increased interoperability
unnecessary treatment. Providers must be able to quickly view medical records, regardless
Tennessee Health Care Initiative Innovation
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3 Strategies: Primary Care Transformation
Episodes of Care Long Term Services and Supports
Tennessee Health Care Initiative Innovation
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PCMH model includes the following:
Patient-Centered Access: Providing same-day appointments for routine and urgent care Team-Based Care: Conducting scheduled patient care team meetings or a structured communications process Population Health Management: Using risk stratification to address chronic and acute care services and perform outreach activities Care Management Support: Identifying high-need, high-risk patients for care management and developing care plans with self-care support recommendations Care Coordination and Care Transitions: Tracking referrals; completing follow up and coordination of care transitions Performance Measurement and Improvement: Measuring and tracking quality and efficiency metrics
Improvement Design
Activities with:
performing practices
practices
Oversight
Design
provider performance reports Tools & Resources
Tool improvement and metrics
meeting collaboration with Navigant
Consultant Collaboration TennCare Coordination
Making
Selection
Accuracy
PCMH providers to promote treatment
improve gap closure
education and training for PCMH/THL
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BlueCare’s Role in Primary Care Transformation
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Provider Engagement & Incentive Team Provider Scorecard Provider Performance Reports Provider Reports Provider Engagement Provider Resources
Substance Use Disorder Initiatives
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+ Opioid Stewardship and Safety + Best Care for Substance Use Disorder (SUD) + Medication-Assisted Treatment (MAT) Expansion
aggressive--comprehensive-plan-to-end-tennessee-s-opioid- epidemicemic.html
+ Tele-Education: Project ECHO
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Local SOLUTIONS, Meaningful RESULTS