Leveraging Managed Care to Support Community Health Workers and Promote Population Health
|
|
|
- Brandon Wilkerson
- 8 years ago
- Views:
Transcription
1 Leveraging Managed Care to Support Community Health Workers and Promote Population Health Association of State and Territorial Health Officials (ASTHO) September 9, :30 AM 10:45 AM ET
2 Thomas Pryor US Public Health Service Center for Medicare and Medicaid Innovation
3 Webinar Objectives Describe the importance of building an effective partnership with Medicaid to achieve population health goals. Discuss how states can use the MCO contract as a policy and financing lever to support population health goals. Examine models of how MCOs have successfully financed CHWs.
4 Speakers Sue Moran Senior Deputy Director, Public Health Administration Michigan Department of Health and Human Services
5 September 9, 2015 Susan Moran, MPH Michigan Department of Health and Human Services
6 Population Health Approach Measurement of health outcomes Considers a broad array of determinants Intervention at the community level Shared accountability for health
7 Community Health Workers A Community Health Worker (CHW) is a frontline public health worker Close understanding of the community served Culturally competent Ability to engage and establish trust Link between health/social services and the community
8 Michigan Pathways to Better Health CHWs assess needs related to the social determinants of health Use checklists that trigger Pathways (i.e., protocols for resolving needs) CHW and client work together to achieve the client s health goals Payment model ties reimbursement to intermediate/final outcomes
9 Michigan Medicaid Vision: Create a Medicaid managed care system that maximizes the health status of population through evidence and value based care delivery models. Four Pillars: Population health management Pay for Value Integrated care Structural Transformation
10 Population Management Managing and paying for health care services for a discrete or defined population New partnerships among providers and payers Integrated data support Focus on non traditional health care workforce New care management models Shift from fee for service delivery to bearing financial risk for the populations served ca4a47 4ccd 4e9e 89d9 14d88ec59e8d&ID=50
11 New Requirements for Medicaid Health Plans Population Management Approach Data analysis Address health disparities Substantively engage with community Maintain a CHW to Enrollee Ration of at least one full time CHW per 20,000 enrollee
12 Look for Leverage Opportunities Medicaid Managed Care contractual requirements Medicaid State Plan Amendments and policies State Innovation Model (SIM) Patient Centered Medical Home (PCMH) Transformation initiatives Affordable Care Act State Health Improvement Plan (SHIP)
13 Thank you Contact Information: Susan Moran, Senior Deputy Director Population Health and Community Services Administration Michigan Department of Health and Human Services
14 Speakers Dodie Grovet Clinical Programs Training Manager Molina Healthcare Inc.
15 Molina Healthcare Leveraging Managed Care to Support Community Health Workers Dodie Grovet LISW September 9,2015
16 Molina Healthcare s Vision & Mission We envision a future where everyone receives quality health care. Our mission is to provide quality health care to people receiving government assistance. We strive to be an exemplary organization. 16
17 Discussion At A Glance The Molina Story Lines of Business CHW Employment History Financing Strategies 17
18 Lines of Business 18
19 What is Our Business? Molina Healthcare is a multistate healthcare organization with flexible care delivery systems focused exclusively on government sponsored healthcare programs for low income families and individuals. 19
20 Current Health Plan Footprints Washington Wisconsin Michigan Utah Illinois Ohio California New Mexico South Carolina Texas Florida Puerto Rico 6
21 Specialized Government Programs Medicaid Children s Health Insurance Program (CHIP) Medicare Special Needs Plans (SNP) Duals Health Insurance Marketplace 7
22 CHW Employment History 22
23 How do Community Health Workers fulfill Dr. Molina s purpose to: Treat every patient as if they were your own family? 23
24 CHW Employment History Molina New Mexico story Return on Investment study Enterprise expansion 24
25 Member Identification What is their story? Health Risk Assessment Emergency Department Utilization Report Hospitalization Report / Chronic Conditions High Dollar Cost Report Integrated Care Team recommendations Case Manager referrals HEDIS Missed Services Report 25
26 Outreach About 9 million individuals are dually eligible System for Medicaid and Medicare benefits navigation Duals typically have low incomes and chronic medical conditions CHW According to CMS, Duals comprise a disproportionate Functions share of Medicaid and Medicare spending due to their complex health needs (approximately $120 B annually) Coaching Connector to care Eyes & Ears 26
27 Arthur: A Real Member Story Arthur is a 32 year old male, referred to a CHW by a Molina Case Manager because of frequent ER visits and hospitalizations for various medical conditions. He had been unable to be contacted and it was reported by hospital staff: We don t know how we can help this patient. 27
28 Homeless What We Learned About Arthur Illiterate No family No telephone No knowledge on taking his medicine Sleeping in shelters About 9 million individuals are dually eligible for Medicaid and Medicare benefits Duals typically have low incomes and chronic medical conditions According to CMS, Duals comprise a disproportionate share of Medicaid and Medicare spending due to their complex health needs (approximately $120 B annually) 28
29 What CHW Saw First Hand Arthur s living condition He couldn t read the medication labels About 9 million individuals are dually eligible for Medicaid and Medicare benefits He didn t understand Duals typically the have hospital low incomes discharge and instructions chronic medical conditions According to CMS, Duals comprise a No one knew of his inability to read or write disproportionate share of Medicaid and Medicare spending due to their complex health needs (approximately $120 B Both Arthur and his local providers did not recognize annually) the magnitude of his barriers to receiving appropriate care 29
30 How Arthur Was Helped Arthur was connected to a housing resource which provided Arthur with an apartment. He was referred to a Home Care Agency. Nurse was assigned to arrange Arthur s medicines in a pill box on a weekly basis. Molina provided a KIT Cell Phone, with numbers for Case Manager and CHW entered. Great Call KIT Company arranged for a phone call directing Arthur taking his medicines: time to take the red pill or time to take the blue pill, etc. Arthur was informed of transportation service to take him for his medical appointments. KIT Phone had transportation number programmed for him to easily access the transportation vendor. 30
31 Cost Impact of a Community Health Worker 30,000 Claims Paid 25,000 About 9 million individuals are dually eligible for Medicaid and Medicare benefits 20,000 Duals typically have low incomes and chronic medical conditions 15,000 According to CMS, Duals comprise a disproportionate share of Medicaid and 10,000 Medicare spending due to their complex health needs (approximately $120 B 5,000 annually) Pre Community Connector (CC) Claims Costs 2/1/2011 8/31/2011 One Member 24,510 During CC Claims Costs 9/1/2011 3/31/ ,456 Claims Cost after 2 years 2/1/2013 8/31/ ,044 31
32 Understanding Basic Human Needs Food Shelter Clothing If these basic needs are not being met, it s too hard to focus on health care needs. 32
33 Financing Strategies 33
34 Claims Analysis Retrospective evaluation 4:1 ratio 34
35 Strategies for Sustaining CHW Workforce Grassroots operation Building a business case Insurance Industry Speak the language A Story to Tell Win-Win Proposition 35
36 36
37 Benefits CHW lives in the serviced community Improvement of health care utilization: at a lower, outpatient level with improved quality of life and health outcomes Remove barriers to accessing care Address Social Determinants of Health Member and Provider satisfaction Interdisciplinary Care Team contribution Decreased healthcare costs Responsible stewards of Medicaid funding 37
38 thank you! 38
39 Q&A Please type your question in the chat box. Speakers: Sue Moran, Michigan Department of Health and Human Services Dodie Grovet, Molina Healthcare Inc.
40 THANK YOU!! CONTACT INFO: Sue Moran Dodie Grovet Thomas Pryor Anne De Biasi Megan Miller Courtney Bartlett WEBINAR WILL BE POSTED HERE: Funding support provided by the Health Resources and Services Administration and the de Beaumont Foundation
Medicaid Support for Community Prevention
Medicaid Support for Community Prevention ASTHO Million Hearts Peer Call April 4, 2014 Anne De Biasi Director of Policy Development About TFAH: Who We Are Trust for America s Health (TFAH) is a non-profit,
Transitioning to The Health Home Model in PSH. Presented by Eric Morse, LISW-S, Chief Operating Officer
Transitioning to The Health Home Model in PSH Presented by Eric Morse, LISW-S, Chief Operating Officer Our Mission Reaching out to adults and children in Northeast Ohio to end homelessness, prevent suicide,
Medicare: 2015 Model of Care Training 04/2015
Medicare: 2015 Model of Care Training 04/2015 1 Model of Care Training This course is offered to meet the CMS regulatory requirements for Model of Care Training for our Special Needs Plans. It also ensures
Note: This Fact Sheet outlines a Proposed Rule. Any of the specifics of this fact sheet could change based on the promulgation of a Final Rule.
Fact Sheet on Proposed Rule: Medicaid Payment for Services Furnished by Certain Physicians and Charges for Immunization Administration under the Vaccines for Children Program Note: This Fact Sheet outlines
Case managers as connectors, educators, advocates in the new insurance marketplace
Case managers as connectors, educators, advocates in the new insurance marketplace Mandy Cohen, MD Senior Advisor to the administrator Centers for Medicare & Medicaid Services Patrice Sminkey Chief Executive
Patient Navigators and Community Health Workers: The Evolving Role of Certification
Patient Navigators and Community Health Workers: The Evolving Role of Certification Presented by: Jan Chamness, MPH, Public Health Director, Montgomery County Health Department Frances J. Feltner, DNP,
Proven Innovations in Primary Care Practice
Proven Innovations in Primary Care Practice October 14, 2014 The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA. 2014 Society for Healthcare
Dual Eligibles: CMS Integration Efforts at the Federal Level. Ann Duarte Associate Regional Administrator CMS San Francisco
Dual Eligibles: CMS Integration Efforts at the Federal Level Ann Duarte Associate Regional Administrator CMS San Francisco Medicare-Medicaid Enrollees 10 million (approx) individuals with Medicare and
Home Care Association of WA April 15, 2015. Health Homes and Accountable Communities of Health State Innovation Model (SIM)
Home Care Association of WA April 15, 2015 Health Homes and Accountable Communities of Health State Innovation Model (SIM) 1 WASHINGTON STATE HEALTH HOME PROGRAM 2 The Affordable Care Act The Affordable
Medicaid Health Homes Emerging Models and Implications for Solutions to Chronic Homelessness
Medicaid Health Homes Emerging Models and Implications for Solutions to Chronic Homelessness November 2012 Several states have begun implementing the new Medicaid health home benefit created by the Affordable
Dual Eligibles and State Innovations in Care Management
Dual Eligibles and State Innovations in Care Management Ann Kohler, Director of Health Services National Association of State Medicaid Directors American Public Human Services Association Ann.Kohler@aphsa.org
STATE STANDARDS FOR ACCESS TO CARE IN MEDICAID MANAGED CARE
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL STATE STANDARDS FOR ACCESS TO CARE IN MEDICAID MANAGED CARE Suzanne Murrin Deputy Inspector General for Evaluation and Inspections September
Health Homes for Patients with Complex Needs: Program Development Considerations
Health Homes for Patients with Complex Needs: Program Development Considerations ACA Section 2703 Creates the new Health Home optional Medicaid benefit: For intensive care coordination for people with
Response to Serving the Medi Cal SPD Population in Alameda County
Expanding Health Coverage and Increasing Access to High Quality Care Response to Serving the Medi Cal SPD Population in Alameda County As the State has acknowledged in the 1115 waiver concept paper, the
AHLA. Q. Medicaid ACOs: Coming to a Neighborhood Near You. Clifford E. Barnes Epstein Becker & Green PC Washington, DC
AHLA Q. Medicaid ACOs: Coming to a Neighborhood Near You Clifford E. Barnes Epstein Becker & Green PC Washington, DC Jennifer E. Gladieux Senior Health Policy Analyst Health Policy Source, Inc. Alexandria,
Medicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile The National Summary Centers for Medicare & Medicaid Services Introduction... 1 Data Source and General Notes... 2 Types and Ages of Medicare-Medicaid Enrollees...
Medicare-Medicaid Coordination Office
Increasing Access to Seamless, Quality and Person Centered Care Programs for Dual Eligibles Edo Banach Senior Advisor Medicare Medicaid Coordination Office Centers for Medicare & Medicaid Services March
The Impact of Healthcare Reform on Pharmacy Practice. Disclosure
The Impact of Healthcare Reform on Pharmacy Practice Thomas Buckley, MPH, RPh Assistant Clinical Professor University of Connecticut School of Pharmacy Disclosure Thomas Buckley has nothing to disclose
Q&A Summary for Contracting Essentials: You Don't Need an MBA! June 24, 2015. # Questions Answers. General Questions
General Questions 1. Will the PPT be available? Yes, the webinar Contracting Essentials slides and recording are available on the CRE page of the TARGET Center website. 2. Are there similar slides/resources
Your Guide to Medicare Private Fee-for-Service Plans. Heading CENTERS FOR MEDICARE & MEDICAID SERVICES
Heading CENTERS FOR MEDICARE & MEDICAID SERVICES Your Guide to Medicare Private Fee-for-Service Plans This official government booklet has important information about Medicare Private Fee-for-Service Plans
Electronic Health Records: Why are they important?
Electronic Health Records: Why are they important? Linette T Scott, MD, MPH Deputy Director Health Information and Strategic Planning California Department of Public Health November 9, 2009 Presenter Disclosures
Report to Congress. Improving the Identification of Health Care Disparities in. Medicaid and CHIP
Report to Congress Improving the Identification of Health Care Disparities in Medicaid and CHIP Sylvia Mathews Burwell Secretary of the Department of Health and Human Services November 2014 TABLE OF CONTENTS
Meeting Today s Health Care Needs: Leading Change, Advancing Health through Nursing 10/29/14
Meeting Today s Health Care Needs: Leading Change, Advancing Health through Nursing Jonas Nurse Leader Scholar Health Care System Challenges High costs Millions more insured Primary care shortage Fragmentation
Payment Models Workgroup July 13, 2015
Payment Models Workgroup July 13, 2015 Alternative Payment Models: WHAT Are Other SIM States Doing? 2 State Innovation Models (SIM) Initiative Evaluation - Model Test CMS contracted with RTI to develop
STATES COLLECTION OF REBATES FOR DRUGS PAID THROUGH MEDICAID MANAGED CARE ORGANIZATIONS
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL STATES COLLECTION OF REBATES FOR DRUGS PAID THROUGH MEDICAID MANAGED CARE ORGANIZATIONS Daniel R. Levinson Inspector General September
MI Health Link Program Nursing Facility Presentation June 3, 2015. Molina Healthcare of Michigan
Program Nursing Facility Presentation June 3, 2015 Molina Healthcare of Michigan Headline Goes Here The Molina Story In 1980, the late Dr. C. David Molina, founded Molina Healthcare with a single clinic
Community Health Worker Led Diabetes Coaching within the Medical Home
Community Health Worker Led Diabetes Coaching within the Medical Home Christine Snead, RN Erin Kane, MD Baylor Scott & White Health www.alliancefordiabetes.org Objectives Identify tools, resources and
The Obama Administration and Community Health Centers
The Obama Administration and Community Health Centers Community health centers are a critical source of health care for millions of Americans particularly those in underserved communities. Thanks primarily
Assistant Surgeon Policy
Policy Number 2015R5000D Annual Approval Date Assistant Surgeon Policy 11/12/2014 Approved By REIMBURSEMENT POLICY Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You
Electronic Health Record (EHR) Incentive Program. Meaningful Use Frequently Asked Questions Webinar
Electronic Health Record (EHR) Incentive Program Meaningful Use Frequently Asked Questions Webinar OFFICE OF MEDICAL ASSISTANCE PROGRAMS FEBRUARY December October 7, 30, 2013 2011 Office of Medical Assistance
Testimony. Submitted to the. U.S. Senate Subcommittee on Public Health. Hispanic Health Improvement Act of 2002
Testimony Submitted to the U.S. Senate Subcommittee on Public Health Hispanic Health Improvement Act of 2002 by Elena Rios, M.D., M.S.P.H. President & CEO National Hispanic Medical Association CEO, Hispanic-Serving
Issue Brief: Minimum Medical Loss Ratio Requirements
Issue Brief: Minimum Medical Loss Ratio Requirements The term Medical Loss Ratio or MLR refers to the share of premium revenues that an insurer or health plan spends on patient care and quality improvement
OHIO CONSUMERS FOR HEALTH COVERAGE POLICY PRIORITIES FY 2012-13. Medicaid Make Improvements to Improve Care and Lower Costs
OHIO CONSUMERS FOR HEALTH COVERAGE POLICY PRIORITIES FY 2012-13 Ohio Consumers for Health Coverage supports robust implementation of the Patient Protection and Affordable Care Act (ACA) in Ohio, making
Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: February 19, 2014
Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: February 19, 2014 Introduction The Office of Mental Health (OMH) licensed and regulated Assertive Community
2014 CAHPS Health Plan Survey Database
THE CAHPS DATABASE 214 CAHPS Health Plan Survey Database 214 Chartbook: What Consumers Say About Their Experiences with Their Health Plans and Medical Care AHRQ Contract No.: HHSA292133C Managed and prepared
Health Homes in Medicaid
Health Homes in Medicaid Melissa Cuerdon, MSW, LCSW-C and Christa Speicher, MPH Disabled and Elderly Health Programs Group Centers for Medicaid & CHIP Services Centers for Medicare and Medicaid Services
Growth and Dispersion of Accountable Care Organizations in 2015
Growth and Dispersion of Accountable Care Organizations in 2015 Growth and Dispersion of Accountable Care Organizations in 2015 by David Muhlestein March 31st, 2015 In January, an additional 89 provider
Accelerating Innovation in Health Care Payment and Delivery: The CMS Innovation Center
Accelerating Innovation in Health Care Payment and Delivery: The CMS Innovation Center William J. Kassler, MD, MPH Chief Medical Officer, New England Region Center for Medicare & Medicaid Innovation We
08/24/2015. Medicare-Medicaid Coordination Office. Medicare-Medicaid Enrollee Delivery System Transformation. Section 2602 of the Affordable Care Act
Improving Care for Medicare-Medicaid Enrollees Centers for Medicare & Medicaid Services August 19, 201 Section 2602 of the Affordable Care Act Purpose: Improve quality, reduce costs and improve the beneficiary
Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: December 6, 2013
Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: December 6, 2013 Introduction The OMH licensed and regulated Assertive Community Treatment Program (ACT) will
Research Brief. Are Medicaid and Private Dental Insurance Payment Rates for Pediatric Dental Care Services Keeping up with Inflation?
Are Medicaid and Private Dental Insurance Payment Rates for Pediatric Dental Care Services Keeping up with Inflation? Authors: Kamyar Nasseh, Ph.D.; Marko Vujicic, Ph.D. The Health Policy Institute (HPI)
Introduction to Medication Management Systems, Inc. Comprehensive Medication Therapy Management Solutions
Introduction to Medication Management Systems, Inc. Comprehensive Medication Therapy Management Solutions Vision Medication Management Systems, Inc. (MMS) envisions a health care system in which all patients
Colorado Choice Health Plans
Quality Overview Colorado Choice Health Plans Accreditation Exchange Product Accrediting Organization: Accreditation Status: URAC Health Plan Accreditation (Marketplace HMO) Provisional Accreditation Commercial
Ohio s Care Coordination Program A Proven Opportunity for a new way in Ohio s Medicaid Program
Ohio s Care Coordination Program A Proven Opportunity for a new way in Ohio s Medicaid Program Ohio s Status Quo: The economy and reliance on one time funding has led to an $8 billion shortfall State expenditures
AS MEDICAID EXPANSION PROGRESSES:
AS MEDICAID EXPANSION PROGRESSES: New Opportunities & Challenges Connecting Homeless Clients to Coverage & Care May 9, 2015 STATE OF AFFAIRS 29 states + DC have expanded Medicaid under ACA As of January
Exploring the Impact of the RAC Program on Hospitals Nationwide
Exploring the Impact of the RAC Program on Hospitals Nationwide Overview of AHA RACTrac Survey Results, 4 th Quarter 2010 For complete report go to: http://www.aha.org/aha/issues/rac/ractrac.html Agenda
A Sustainable Source for Services through Health Home Legislation: What it Means for Supportive Housing
A Sustainable Source for Services through Health Home Legislation: What it Means for Supportive Housing The Source for Housing Solutions Sharon Rapport, CSH Lezlie Murch, Exodus Recovery Brenda Goldstein,
Strategies for Success in the CMS Medicare Advantage Star Quality Ratings
Strategies for Success in the CMS Medicare Advantage Star Quality Ratings The National Pay for Performance Summit February 20, 2013, San Francisco, CA Theresa C. Carnegie Mintz, Levin, Cohn, Ferris, Glovsky
Medicare Advantage Plans
2016 BlueCross BlueShield of Western New York Medicare Advantage Plans Gloria and Anai, Members Y0086_MRK1528rev2 Accepted The benefits of Blue Understanding Medicare and choosing a health plan are not
Engaging the Community: Involving Patients and their Providers in ACOs
Taconic Health Information Network and Community w w w. t h I n c. o r g Engaging the Community: Involving Patients and their Providers in ACOs THINC ACO Insights Program Webinar Three: September 27, 2011
Medicare may pay for inpatient hospital, doctor, or ambulance services you receive in Canada or Mexico:
Medicare Beneficiary Services:1-800-MEDICARE (1-800-633-4227) TTY/ TDD:1-877-486-2048 Thank you for your recent request for the Patient s Request for Medical Payment form (CMS-1490S). Enclosed is the form,
Coastal Health & Wellness Clinic Billing and Collection Policy
Coastal Health & Wellness Clinic Billing and Collection Policy Approved GB 10/01/2015 -Effective 08/24/2014 The Coastal Health &Wellness Clinic is committed to ensuring everyone in Galveston County receives
Special Needs Plan Model of Care 101
Special Needs Plan Model of Care 101 What is a Special Needs Plan? First of all it s a Medicare MA-PD, typically an HMO Consists of Medicare enrollees who meet special eligibility requirements In our case
2014 Model of Care Training SHP_2014838A
2014 Model of Care Training SHP_2014838A 1 Model of Care Training This course is offered to meet the CMS regulatory requirements for Model of Care Training for our Special Needs Plans. It also ensures
Medicare. If you have any other questions, please feel free to call us at 1-800-MEDICARE (1-800-633-4227). Sincerely,
Medicare Beneficiary Services:1-800-MEDICARE (1-800-633-4227) TTY/ TDD:1-877-486-2048 Thank you for your recent request for the Patient s Request for Medical Payment form (CMS-1490S). Enclosed is the form,
Center for Medicaid and CHIP Services SMDL# 12-002 ICM# 2
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 Center for Medicaid and CHIP Services SMDL# 12-002
Medicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant
Medicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant Issue Summary The term dual eligible refers to the almost 7.5 milion low-income older individuals or younger persons with disabilities
Summary. Program Background
Integrative Therapies Pilot Project: A Holistic Approach to Chronic Pain Management in Medicaid The Florida Medicaid Experience A report by Health Management Associates, Inc. Summary Chronic pain remains
Center for Medicare and Medicaid Innovation
Center for Medicare and Medicaid Innovation Summary: Establishes within the Centers for Medicare and Medicaid Services (CMS) a Center for Medicare & Medicaid Innovation (CMI). The purpose of the Center
DSRIP QUARTERLY REVIEW PROCESS: Project Requirement - Timeframe. Project Requirement - Unit Level Reporting
DSRIP QUARTERLY REVIEW PROCESS: PPSs will submit a quarterly report to the Independent Assessor throughout the DSRIP program via the automated MAPP tool which includes Domain 1 DSRIP Requirement Milestone
LEARNING WHAT WORKS AND INCREASING KNOWLEDGE
About This Series In February 2010, the George Washington University School of Public Health and Health Services, Department of Health Policy released Changing po 2 licy: The Elements for Improving Childhood
Medicare Advantage Plan Landscape Data Summary
2013 Medicare Advantage Plan Landscape Data Summary Table of Contents Report Overview...3 Medicare Advantage Costs and Benefits...4 The Maximum Out of Pocket (MOOP) Benefit How It Works...4 The Prescription
High Risk Health Pools and Plans by State
High Risk Health Pools and Plans by State State Program Contact Alabama Alabama Health 1-866-833-3375 Insurance Plan 1-334-263-8311 http://www.alseib.org/healthinsurance/ahip/ Alaska Alaska Comprehensive
19 June 2014. 888.879.7302 www.greenwayhealth.com
Meaningful Use Timeline Changes and Penalties Explained By: Adele Allison, National Director of Industry and Government Affairs Greenway Health On May 20, 2014, CMS issued a proposed rule offering flexibility
Modify the Institutions for Mental Disease (IMDs) exclusion for capitation payments
July 27, 2015 Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-2390-P 7500 Security Boulevard Baltimore, MD 21244 SUBMITTED ELECTRONICALLY Re: CMS-2390-P:
Patient Protection and Affordable Care Act [PL 111-148] with Amendments from 2010 Reconciliation Act [PL 111-152] Direct-Care Workforce
![Patient Protection and Affordable Care Act [PL 111-148] with Amendments from 2010 Reconciliation Act [PL 111-152] Direct-Care Workforce](/thumbs/25/6872632.jpg "Patient Protection and Affordable Care Act [PL 111-148] with Amendments from 2010 Reconciliation Act [PL 111-152] Direct-Care Workforce")
DIRECT-CARE WORKFORCE AND LONG-TERM CARE PROVISIONS AS ENACTED IN PATIENT PROTECTION AND AFFORDABLE CARE ACT AND HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010 Key Provisions Direct-Care Workforce
INTEGRATING HOUSING IN STATE MEDICAID POLICY
INTEGRATING HOUSING IN STATE MEDICAID POLICY April 2014 INTRODUCTION As evidence continues to establish supportive housing as an intervention that stabilizes people with chronic illnesses and/or behavioral
Medicare Advantage Cuts in the Affordable Care Act: March 2013 Update Robert A. Book l March 2013
Medicare Advantage Cuts in the Affordable Care Act: March 2013 Update Robert A. Book l March 2013 The Centers for Medicare and Medicaid Services (CMS) recently announced proposed rules that would cut payments
Facing Cost-Sensitive Shoppers, Health Plan Providers Must Demonstrate Value
w Reports: Health Insurance Marketplace Exchange Enrollment Satisfaction Improves Significantly in Second Year Facing Cost-Sensitive Shoppers, Health Plan Providers Must Demonstrate Value WESTLAKE VILLAGE,
The manual is organized into sections identified by tabs showing main topics. The subtopics are listed in the Table of Contents.
Overview Section A-1 Provider Manual 2012 Purpose This Provider Manual has been prepared to serve as a guide for working with Molina Healthcare of New Mexico, Inc. (Molina Healthcare) managed care products.
Preferred Provider Organization (PPO) Plans
CENTERS FOR MEDICARE & MEDICAID SERVICES Your Guide to Medicare s Preferred Provider Organization (PPO) Plans This official government booklet has important information about the following: Understanding
Health Homes, Equity, and the ACA: Working to Leverage Opportunity in a Changing Health Care Landscape
Health Homes A C A Health Equity Health Homes, Equity, and the ACA: Working to Leverage Opportunity in a Changing Health Care Landscape Dennis P. Andrulis, PhD, MPH Senior Research Scientist, Texas Health
Accelera'ng Care and Payment Innova'on: The CMS Innova'on Center
Accelera'ng Care and Payment Innova'on: The CMS Innova'on Center Healthcare IT Connect Sean Cavanaugh Deputy Director Center for Medicare and Medicaid Innova:on May 21, 2013 The CMS Innovation Center Identify,
SYNOPSIS OF HEALTH CARE QUALITY MANAGEMENT SYSTEMS
SYNOPSIS OF HEALTH CARE QUALITY MANAGEMENT SYSTEMS Administration for Community Living CBO Learning Collaborative Webinar Presenter: Sharon R. Williams, Health Care Consultant April 2, 2014 2 QUALITY ASSURANCE:
Agency for Health Care Administration. Overview of Federal Affordable Care Act
Agency for Health Care Administration Overview of Federal Affordable Care Act October 17, 2011 Analysis This analysis addresses only the direct impact of changes to enrollment in the Title XIX (Medicaid)
TABLE OF CONTENTS. Claims Processing & Provider Compensation
TABLE OF CONTENTS Claims Address... 2 Claim Submission... 2 Claim Payment... 2 Claim Payment Adjustments.... 2 Claim Disputes... 2 Recovery of Overpayments... 3 Balance Billing... 3 Annual Health Assessment
Parkview Health s Population Health Journey
Parkview Health s Population Health Journey Susan McAlister DNP, RN Director Enterprise Care Management Christine Howell BSN, RN Community Based Registered Nurse Objectives: By the completion of the webinar
Health Homes (Section 2703) Frequently Asked Questions
Health Homes (Section 2703) Frequently Asked Questions Following are Frequently Asked Questions regarding opportunities made possible through Section 2703 of the Affordable Care Act to develop health home
Medicaid Funding of Community-Based Prevention Myths, State Successes Overcoming Barriers and the Promise of Integrated Payment Models
Medicaid Funding of Community-Based Prevention Myths, State Successes Overcoming Barriers and the Promise of Integrated Payment Models Prepared by: Alice Burton, MHS Debbie I. Chang, MPH Daniella Gratale,
Summary Enrollment Report, which can be accessed at http://aspe.hhs.gov/health/reports/2014/marketplaceenrollment/apr2014/ib_2014apr_enrollment.pdf.
ASPE ISSUE BRIEF HEALTH INSURANCE MARKETPLACE 2015 OPEN ENROLLMENT PERIOD: JANUARY ENROLLMENT REPORT For the period: November 15, 2014 January 16, 2015 1 January 27, 2015 The Health Insurance Marketplace
Improving Public Health thru Mobility Management Connecting Transportation to Health: Rides to Wellness
Improving Public Health thru Mobility Management Connecting Transportation to Health: Rides to Wellness Judy Shanley, Ph.D. Asst. Vice President, Education & Youth Transition Co-Director, National Center
Supporting Social Service Delivery through Medicaid Accountable Care Organizations: Early State Efforts
BRIEF February 2015 Supporting Social Service Delivery through Medicaid Accountable Care Organizations: Early State Efforts By Roopa Mahadevan and Rob Houston, Center for Health Care Strategies T IN BRIEF
Health and Medical Billing Requirements in Minnesota
Improving Access to Preventive Services Emerging Practices from Community Transformation Grant projects Kala Shipley Iowa Department of Public Health Cherylee Sherry Minnesota Department of Health Robert
VNS CHOICE: Managing Complex Care Needs for the Frail Elderly of New York City. Roberta Brill Vice President, VNS Health Plans
VNS CHOICE: Managing Complex Care Needs for the Frail Elderly of New York City Roberta Brill Vice President, VNS Health Plans VNS CHOICE Organization Subsidiary of the Visiting Nurse Service of New York
Commonwealth of Virginia. Medicaid Dental Program Review. October 2010
Commonwealth of Virginia Medicaid Dental Program Review October 2010 EXECUTIVE SUMMARY The Centers for Medicare & Medicaid Services (CMS) is committed to improving pediatric dental care in the Medicaid
HIPAA 5010 It is important to prepare now Deanna Stohl ETP Contracting and Relations e-business Interchange Group Blue Cross Blue Shield Michigan
HIPAA 5010 It is important to prepare now Deanna Stohl ETP Contracting and Relations e-business Interchange Group Blue Cross Blue Shield Michigan August 31, 2011 1 Housekeeping Please place your phones
Behavioral Health Treatment Needs Assessment Toolkit for States
Behavioral Health Needs Assessment Toolkit for States ACKNOWLEDGMENTS This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) by Truven Health Analytics Inc,
Partnering with Managed Care Organizations: A Case Study for Success
Partnering with Managed Care Organizations: A Case Study for Success Tracy Altman, M.H.Ed. Manager, Provider Services & Contracting Molina Healthcare Most Trusted on ACA: Doctors and Nurses, Federal and
Gaidaid Medicaid - A Great Initiative to Improve Performance and Provide Disease
69 th Annual Meeting of the Southern Legislative Conference Medicaid Behavioral Health Homes Integrating Services- Overview and Implementation Advice Savannah, GA July 19, 2015 Michael S. Varadian, JD,
State and Federal Health Care Reform Update. Universal Health Care Foundation of Connecticut
State and Federal Health Care Reform Update Universal Health Care Foundation of Connecticut Linda Dahlmeyer, CPA Vice President for Finance and Administration ldahlmeyer@universalhealthct.org Jill Zorn,
NAMD WORKING PAPER SERIES. Advancing Medicare and Medicaid Integration: An Update on Improving State Access to Medicare Data
NAMD WORKING PAPER SERIES Advancing Medicare and Medicaid Integration: An Update on Improving State Access to Medicare Data May 2012 444 North Capitol Street, Suite 309 Washington, DC 20001 Phone: 202.403.8620
2013 Medicare Update: Therapy Claims Based Data Collection of Information Regarding Function
PO Box 4553 Missoula, MT 59806 4553 P: 877 636 4408 F: 866 861 4675 E: office@aptahpa.org www.aptahpa.org 2013 Medicare Update: Therapy Claims Based Data Collection of Information Regarding Function Frequently
Community Health Workers and Reducing Disparities in Diabetes: Lessons Learned From the Front Lines of Care
Community Health Workers and Reducing Disparities in Diabetes: Lessons Learned From the Front Lines of Care Monday, June 17 th, 2013 12:00 1:00 pm ET Sponsored by The Merck Company Foundation www.alliancefordiabetes.org
While health care reform has its foundation and framework at
CENTER FOR HEALTHCARE RESEARCH & TRANSFORMATION Policy Brief June 2010 The Patient Protection and Affordable Care Act at the State and Local Level While health care reform has its foundation and framework
Frequently Asked Questions Recovery Auditor Outpatient Therapy Claims As of April 17, 2013
Frequently Asked Questions Recovery Auditor Outpatient Therapy Claims As of April 17, 2013 1. Q. Why is CMS conducting manual review on therapy claims? A. On January 2. 2013 President Obama signed into
For any questions not answered by materials provided within this profile, please contact Wayne Pendleton, CEO of LIFE, at wayned@nursing.upenn.edu.
For More Information For any questions not answered by materials provided within this profile, please contact Wayne Pendleton, CEO of LIFE, at wayned@nursing.upenn.edu. Or contact Shawn Bloom, President
Pushing the Boundaries of Population Health Management: How University Hospitals Launched Three ACOs July 26, 2013 American Hospital Association
Pushing the Boundaries of Population Health Management: How University Hospitals Launched Three ACOs July 26, 2013 American Hospital Association Eric J. Bieber, M.D. Chief Medical Officer, University Hospitals
NON-RESIDENT INDEPENDENT, PUBLIC, AND COMPANY ADJUSTER LICENSING CHECKLIST
NON-RESIDENT INDEPENDENT, PUBLIC, AND COMPANY ADJUSTER LICENSING CHECKLIST ** Utilize this list to determine whether or not a non-resident applicant may waive the Oklahoma examination or become licensed
July 15, 2015. Dear April Leonhard:
July 15, 2015 April Leonhard Department of Human Services Office of Long Term Living, Bureau of Policy and Regulatory Management P.O. Box 8025 Harrisburg, PA 17105-8025 Dear April Leonhard: Thank you for