Community and Clinical Engagement Initiatives
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1 Community and Clinical Engagement Initiatives March 17, 2015 Presented by: Michael Archuleta, DNP (C), MSN, RN, NE-BC, CPHQ, CPHM Director Member Engagement & Advocacy
2 Molina Healthcare of New Mexico is a managed care organization that arranges for the delivery of health care services to low-income families and individuals who are eligible for government-sponsored programs in the state of New Mexico. Molina Healthcare of New Mexico also offers a direct delivery system which includes a company-owned-and-operated primary care office. Centennial Care (Medicaid) Medicare Marketplace 2
3 Mission Our mission is to provide quality health services to financially vulnerable families and individuals covered by government programs. Molina strives to be an exemplary organization: We care about the people we serve and advocate on their behalf. We provide quality service and remove barriers to health services. We are health care innovators and embrace change quickly. We respect each other and value ethical business practices. We are careful in the management of our financial resources and serve as prudent stewards of the public funds. 3
4 Molina Healthcare of New Mexico Company Profile Serving Member since 1998 (Cimarron Health Plan) Accredited by NCQA (National Committee for Quality Assurance) Rated #1 Medicaid Health Plan in New Mexico (4 th Consecutive Year) Employees: 1,003 (Feb 2015) Membership: 227,246 (Jan 2015) Recognized Top Places to Work by the Albuquerque Journal (2 nd Consecutive Year) Provider Network Primary Care Physicians and Practitioners (PCPs) - 1,900 Specialists - 7,650 Hospitals 70 Ancillary Services 2,350 Core Services Agencies
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6 Community Connector Program A statewide program designed to improve the quality of health care and access to care through the extended involvement of the Community Connector. Empower Members to develop self-management skills. Connect Members to a Medical Home to ensure the appropriate level of care. 6
7 Community Connector Program Benefits Face to Face intervention Community Connector who lives in the Member s Community Healthcare delivery is a team approach Reduce health disparities Who we Serve Members who have difficulty accessing healthcare services; Members who have chronic health conditions (such as asthma, diabetes, medically fragile) 7
8 Community Connector Program How We Serve Reduce non-emergent emergency department visits Connect Members to a Medical Home Bridge communication between Member and Healthcare Providers Home visits Link to community resources Remove barriers to care. 8
9 Care Coordination Understand your benefits Identify community resources for services. Every Member receives a Health Risk Assessment that assist Molina Healthcare staff work together to create a care plan based on Member needs. There three levels of care coordination. With the higher the level (acuity) the more services are required to manage and care for the Member. Referrals are made to community resources, when appropriate. 9
10 Transitions Program The Transitions Program offers assistance and support for our members in transitioning from one care setting to another and helps to ensure the coordination and continuity of care as the member s health status changes. Effectively transition members from one setting to another The program is 4-6 weeks with a TOC Coach conducting face-to-face visits and phone contacts Utilize six fundamental elements or pillars Promote member self-management while encouraging empowerment. Engage members directly 10
11 Transitions Program Help the member stay out of the hospital and be able to manage their care at home. Ensure the member follows up with their PCP within 7 days of discharge from the hospital. Ensure the member is able to obtain their discharge medications, any durable medical equipment or needed services upon discharge. Work closely with the member, hospital case managers and physicians to ensure a smooth transition to an alternate care setting and/or to the member s home. 11
12 Transitions Program Six Critical Components Medication Management Personal Health Record (MHR) Follow-Up Care Knowledge of warning signs & Red flags Nutrition Management Home & Community Based Services 12
13 Patient Centered Medical Home (Molina Advances PCMH) A PCMH puts the patient at the center of the health care system, and according to the American Academy of Pediatrics, provides primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. 13
14 Patient Centered Medical Home (Molina Advances PCMH) Molina Healthcare of New Mexico is playing a key role in the development of patient-centered medical homes pioneering new provider incentive structures, and PCMH modules that are easy adaptable to provider practices. Molina Healthcare of New Mexico is funding a medical home initiative and while its too early in most cases to measure return on investment, the initial response is promising. 14
15 Patient Centered Medical Home (Molina Advances PCMH) The Medical Home model s cohesive team of nurse managers, facilitated by electronic health records, allows healthcare practitioners to apply best practices to achieve optimal patient results. Medical Homes can help reduce care utilization, such as Emergency Room Visits, Inpatient Days and Radiology. Medical Homes foster improved care management of chronic conditions such as Diabetes, Asthma and Hypertension. 15
16 Health Education Programs National Diabetes Prevention Program (NDPP) For Members who at risk for diabetes. The program is a 16-week lifestyle change program to help Member lower their risk of type 2 diabetes. Member must meet qualifying characteristics for program participation.. 16
17 Health Education Programs MyCD (My Chronic Disease) Program Six (6) week peer-led, community-based intervention that helps Members 18 years of age and older with chronic conditions learn how to manage their condition and improve their health. Member must meet qualifying characteristics for program participation. 17
18 Project Echo Case Presentation reimbursement Provider Stipends 18
19 Behavioral Health Services Peer Support Specialist Family Support Services Dropin Centers (Peer Driven Recovery) Wellness Centers (Peer Driven Recovery) Mental Health and Drug Abuse, Access, Community Resources, Groups natural supports within their community. Transitional Living Services (Alive) 19
20 20
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