Stepping-Up Conference Our MISSION To make a lasting difference in - - PowerPoint PPT Presentation
Stepping-Up Conference Our MISSION To make a lasting difference in - - PowerPoint PPT Presentation
Stepping-Up Conference Our MISSION To make a lasting difference in our members' lives by improving their 1.8M health and well-being. members CARESOURCE A nonprofit health plan and national leader in Managed Care 27-year history of
- A nonprofit health plan and national leader
in Managed Care
- 27-year history of serving the low-income
populations across multiple states and insurance products
- Currently serving over 1.5 million members
in Kentucky, Ohio, Indiana, West Virginia, and Georgia
- 1.2 million Ohio Medicaid members
CARESOURCE
1.8M
members
Our MISSION
To make a lasting difference in our members' lives by improving their health and well-being.
Confidential & Proprietary
Why - Living Our Mission
3
Making a lasting difference in the lives of our members by improving their health and well-being.
Medicaid Expansion Disproportionate Chronic Health Conditions Behavioral Health (Institutionalization) Behavioral Health Carve-In
Behavioral Health Carve In and Redesign: What it
Means
What is Carve In and Redesign
Community Behavioral Health Systems are being “carved-in” to Managed Care 2 Phases Redesign 1/1/18 Carve In 7/1/18. At that time all FFS billing goes away and the state pays a capitated rate to the plans for Medicaid members.
What is the goal…
Better address BH needs
Ensure access to care Improve members experience Reduce ED and psychiatric inpatient care Bring BH codes up to NCCI
Who does it impact?
Everyone who is receiving mental health services and is enrolled in an MCO 420+ CBHCs in Ohio Approximately 100K members in CBHCs Additional100K members that NEED CBHC
Now responsible for members physical and behavioral health benefit. Opportunity to work with BH and CJ systems to identify and fill gaps. Provide population health approach to CJ population with high prevalence of BH and chronic conditions.
Managed Care’s Role
Community Transition Program (CTP)
Community Transition Program (CTP) Grant
OhioMHAS To administer clinical SUD services (for non-Medicaid population) & Recovery Services, including housing, transportation, vocational support Starts July 1, 2016
- Initial 1 year
contract renewed through June 2019
- Goal to create
quality, scalable program for prison reentry for SUD population Eligible Population Individuals released from an Ohio prison who received SUD treatment while incarcerated
Confidential & Proprietary
The CTP Benefit
RECEIPIENTS WILL RECEIVE:
Confidential & Proprietary
Treatment Services
Available to CTP Members without Medicaid or other Health Insurance
Diagnostic Assessment Intensive Outpatient Services Urinalysis Outpatient Individual and Group SUD Residential Treatment Case Management MAT Crisis Intervention Ambulatory Detoxification including Naloxone
Recovery Services
Non-Medicaid Reimbursable available to all CTP Members
Housing (Recovery Housing, Permanent Supporting Housing) Employment Services, Job Training and Education Peer Recovery Supporter Transportation Life Skills Relapse Prevention Spiritual Support Individual and/or Group Identity Fund Administrative (In-Reach, Recovery Case Management, Data Collection)
Provider Network
Confidential & Proprietary
66 Providers OhioMHAS AOD Certified 230+ Locations 66 Counties
- Approx. 90 Providers
AOD Certified + Additional Provider Types 88 County Coverage CJ Competencies (In-Reach, Rec Case Mgmt.) Current Future
CTP Housing Model
Emergency Housing (14 Day Limit)
CSH MANAGED
- Mitigation Services
- Home Based Case Management
- Mental Health
- Resource Referrals
- Vocational Support
Housing Supports
CTP Member Assessed Prior to Release (JD VI SPDAT) Peer Support
Confidential & Proprietary
Ohio Recovery Housing Associates CTP Provider Owned and Operated Four Month Max Rental Benefit Landlord Based 4 Month Max Rental Benefit Benefit available until transition to permanent subsidy Estimated to be 10% of housing population for CTP
PSH Rapid Rehousing Recovery Housing
Who Does Life Services Serve?
CareSource Proprietary
Social Determinants of Health
CareSource Proprietary Health-related social needs are found where people live, learn, work and socialize; they impact health outcomes.
+ + +
HEALTH
HOUSING &
NEIGHBORHOODS
̶ ACCESS TO HEALTHY FOODS ̶ INCREASED QUALITY OF SAFE & AFFORDABLE HOUSING ̶ IMPROVED ENVIRONMENTAL CONDITIONS
$
ECONOMIC STABILITY
̶ ACCESS TO LONG- TERM EMPLOYMENT ̶ ACCESS TO FINANCIAL LITERACY ̶ ACCESS TO ADULT EDUCATION & JOB TRAINING ̶ INCREASED ASSETS SUCH AS HOME OWNERSHIP
SOCIAL
RELATIONSHIPS
̶ SOCIAL COHESION ̶ CIVIC PARTICIPATION ̶ PERCEPTIONS OF DISCRIMINATION & EQUITY ̶ INCARCERATION / INSTITUTIONALIZA- TION
HEALTH-RELATED SOCIAL NEEDS
EDUCATION
̶ EARLY CHILDHOOD EDUCATION & DEVELOPMENT ̶ ACCESS TO EXTRACURRICULAR ACTIVITIES & MENTORING ̶ INCREASED HIGH SCHOOL GRADUATION ̶ ENROLLMENT IN JOB TRAINING OR POST SECONDARY EDUCATION
FOOD & NUTRITION
̶ REGULAR & CONSISTENT ACCESS TO HEALTHY FOODS ̶ EDUCATION ON NUTRITION & OVERALL HEALTH IMPACTS ̶ ADDRESSING FOOD DESERTS & INEQUALITIES
+
Family of 3 in
MONTGOMERY COUNTY OHIO
*50% of FPL (4.91 / hr) ** 80% of median income Current focus is on meeting needs of individuals below 30% of Median Income, which is $7.37/hr for Montgomery County*
$4 $6 $8 $10 $12 $14 $16 $18 $20 $22 $24 $26 100% 133% 150% 200% 250% Federal Poverty Line ($20,420 or $9.82/hr)
Childcare Assistance (125%-300%) 300% FPL SNAP(130%) WIC (185%) Medicaid – Kids (206%) Medicaid – Adults (138%) Housing** Retail Salespersons ($9.63) Food Svc. Prep ($8.71) Registered Nurse ($29.17) Cashiers ($8.95) Office Clerks ($13.17) Stock and Material Movers ($10.97)
Waiters& Waitress. ($8.75)
- Janitors. ($10.79)
Customer Svc. Rep. ($14.63) Nursing Aides and Orderlies ($11.40)
Self-Sufficiency Standard Line ($40,840 or $19.63 / hr) Top Jobs in Ohio
(shown by percent of the population in each position)
Benefits
Minimum Wage ($8.15/hr) OWF*
Active participants working with Coaches.
1,437 4,671
Members who have interacted with Life Services. Employed Members
64
Employer Partners
4,622
Total Community Referrals Members who have retained employment.
87%
Life Services Outcomes & Member Metrics
- Currently operating in 10 Ohio Counties
CareSource Proprietary
568 1,509
Members who have opted into Life Services.
- CareSource Members are given
access to holistic services.
- CareSource Members are being
assisted in all areas of their life with a coordinated holistic approach.
- CareSource Life Services has
tracked the number of organizations and programs that member utilize –
- n average members are engaged
with 7-10 different organizations to help them survive month to month.
- We are tracking the time it takes
to see government & community resources replaced by income. LIFE SERVICES
Health Care Including Mental & Behavioral Health Life Skills & Assessments Social & Community Needs Education & Training Job Connection & Retention Coaching & Mentoring
Unique Opportunity
CareSource Proprietary