Stepping-Up Conference September 28, 2017 | Molina Healthcare of - - PowerPoint PPT Presentation

Stepping-Up Conference

September 28, 2017 | Molina Healthcare of Ohio Deidre Palmer, MSEd, LPC, LSW

The Molina Story

Three Decades of Delivering Access to Quality Care

Molina Healthcare’s history and member- focused approach began with the vision of

• Dr. C. David Molina, an emergency

department physician who saw people in need and opened a community clinic where caring for people was more important than their ability to pay. Today Molina Healthcare serves the diverse needs of over 4 million plan members and beneficiaries across the United States through government-funded programs. Molina Healthcare provides NCQA-accredited care and services that focus on promoting health, wellness and improved patient outcomes. We treat everyone like family, just as Dr. Molina did – making Molina Healthcare your extended family.

The Ohio Department of Medicaid Covered Benefits and Services

4

Ohio Medicaid Managed Care Benefits

• The following includes but is not limited to a general list of the benefits covered

by Medicaid and MCPs:

• Inpatient hospital services
• Outpatient hospital services (including those provided by rural health

clinics & federally qualified health centers)

• Physician services
• Laboratory and x-ray services
• Prescriptions
• Dental
• Vision
• Durable Medical Equipment (DME)

5

Value Added Benefits

• Additional

transportation benefits

• Statewide Network of

Providers

• 24-Hour Nurse Advice

Line

• Care Management
• Enhanced Dental and

Vision Coverage

• Self-Service Capabilities
• Disease Management

and Health Education Programs

• Member services line

Care Management

Care Coordination

Molina Healthcare’s Person-Centered Approach

Care Managers coordinate care and provide individualized support to each of their members

We work with individuals to:

• Help identify appropriate

caregivers

• Develop an individualized care

plan

• Collaborate with providers
• Coordinate easier access to

needed quality care and social support services

Care Management

• Molina Care Managers work to ensure that inmates with Substance Use

Disorders (SUD) and/or who have been identified with having a Serious and Persistently Mentally Illness (SPMI) are given the proper treatment and support to avoid reoffending. The Care Manager’s role includes assisting the member by : – Linking and Collaborating with Medical and Behavioral Health Providers and Resources – Scheduling appointments & where to obtain medications – Identifying resources necessary to secure housing, employment, food, transportation etc. – Key contact information for the MCP and CM

Ohio Department of Medicaid Managed Care Engagement with Ex-Offenders

M a M a k i n g O h i o B e B e t t e r O H O H I O O D E D E PA R T M E N T N T O F O F M E M E D I C A I D

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DRC Pre-Release Process Overview

• 1. ODRC pre-release interface with Ohio Benefits
• Sends application information for offenders

identified for release within 105 days

• 2. Direct Enrollment Unit processes applications
• ODRC main office address for mailing address: 770
• W. Broad Street
• Physical address is where individual plans to reside

upon release

• 3. ODM coordinates managed care enrollment,

assuring care coordination, and transfer of case to residential county prior to month of release from incarceration

Issues Facing Prisons and Jails

• Inmates are often admitted to jail under the immediate influence of, or with

dependency on alcohol or drugs

• Inmates often have untreated or undiagnosed mental health needs
• Staffing training and education needs – higher level training needed for special

monitoring, on site treatment/care, referrals, etc. for inmates with mental health issues

• Lack of access to information: Immediate need for information about an inmate’s

health, mental health and disabilities to assist with decision making

• Overcrowding resulting in stretched staff capacity to address health related issues
• Need for collaboration with outside agency and stakeholders including managed

care

Opportunities for Collaboration Between Managed Care and Local Agencies and Organizations

• Connect with consumers and each other to facilitate the sharing of

information about the needs and wants of consumers

• Find and refer consumers to qualified healthcare providers to ensure

timely and appropriate access to care.

• Contact MCPs for member materials, such as ID cards, member

handbooks, etc.

• Help consumers identify and access covered and value-added benefits,

including medical services, medications, transportation to medical appointments,

• Refer individuals to MCP care coordination and case management

programs

• Participate in MCP Member Advisory Councils and local re-entry coalitions

Molina Pre-Release Success Stories and Community Partnerships

Molina Pre-Release Success Story

• Mr. W is a 23 year old male diagnosed with Anxiety, ADHD, Mood Disorder, PTSD,

Schizophrenia, Substance Use Disorder, Trauma Related Joint Disorder and Thyroid disorder.

• His Molina Care Manager contacted him for follow up post release and assisted

the member with finding a Dentist and Primary Care Physician by providing him a list of providers near his location.

• Mr. W. reported that he was eager to see a dentist because he had lost many of his

teeth from using methamphetamines.

• Mr. W reported that he was able to attend his scheduled Dentist and Primary Care

Physician appointments and plans to continue to work with his Dentist to receive

• dentures. Mr. Watson reported that he is also engaged in Behavioral Health with a

local Substance Abuse Provider.

• Mr. W remains enrolled in Care Management and reported to his Molina Care

Manager that he plans to complete college applications. He also expressed gratitude to his Molina CM for providing support during his transition.

Community Partnerships

Why Collaborate?

• 1. Prevents Duplication of Work
• Community organizations are running

effective community reentry programs.

• 2. Removes Barriers
• Pilot demonstration programs address social

issues that stand in the way of MCP members receiving healthcare

• Partnerships help to address issues that

contribute to recidivism i.e. lack of employment and job training

Dress for Success Partnership- Pilot

• Referral program targeting members in Cleveland, Central Ohio and Cincinnati

Areas

• Prioritizes members recently released from incarceration
• Participating members receive free suiting, access to career resources, and job

retention coaching services to help them find and keep gainful employment

• Molina’s Care Managers track program completion, program impact, adherence

to required medical appointments and utilization of health insurance benefits.

Columbus Urban League Partnership- Pilot

• Referral program for members in Central Ohio
• Will help over 30 male Molina members address various issues that

negatively impact healthcare including: – Workforce readiness – Challenges facing ex criminal offenders – Stress and anger management – Credit score improvement and budgeting – Broken bonds between children and their fathers

• The community reentry component will link an unlimited number of

Molina members to community resources for housing, transportation, housing and employment

• As part of the workforce readiness component, 20 of the participating

members will obtain interview appropriate attire and mentors who can provide career advice and support

Church and Community Development for All People Partnership- Workforce Development Pilot

• Referral program for members in Central Ohio
• Workforce training program to be offered this September as

part of the new workforce development space on the campus

• f Residences at Career Gateway.
• Molina supporting training programs and job fairs, and

providing member benefits information and referrals

• Prioritizes members recently released form incarceration,

seeking job training and employment opportunities.

Questions ?