Dual Eligible and High Risk Populations: A Case for Integrated Care and Redesign
|
|
|
- Gavin Shelton
- 8 years ago
- Views:
Transcription
1 Dual Eligible and High Risk Populations: A Case for Integrated Care and Redesign Peggy Johnson, MD Chief of Psychiatry, Commonwealth Care Alliance Twitter Handle CCABoston May 15, 2014 DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
2 Disclosure of Conflicts of Interest Conflicts of interest (COI) There are no conflicts of interest
3 Learning Objectives Understand current dysfunctional fragmented and under resource of care provided to individuals with serious and persistent mental illness Understand the two key care delivery innovations developed at Commonwealth Care Alliance for Dual enrollees. Understand metrics to assess clinical care improvement as a consequence of these innovations.
4 Commonwealth Care Alliance (CCA) Commonwealth Care Alliance is a non profit, fully integrated special needs plan contracting with CMS and MassHealth to provide the totality of Medicare/Medicaid benefits to Dual eligible beneficiaries. First demonstration of the ACA s Dual Demonstration Since October 1, 2013, enrolled individuals with Serious Mental Illness meeting Department of Mental Health client eligibility criteria.
5 Care System in need of Redesign and Innovation Primary care is grossly under resourced and poorly designed for those with the greatest need. For many, it is non existent. The more medically and socially complex one is, the more likely one is to be a- drift in a sea of disconnected, unaccountable care providers. Typical health plan based care coordination and management strategies are irrelevant at best, and harmful at worse Psychiatric hospitalizations at a rate of $1100 per day. The only resource available and could be managed in the community
6 Innovations PRIMARY CARE MULTIDISCIPLINARY TEAMS with professional and non professional components with abilities to access, manage and coordinate in multiple settings, REPLACES the 20 minute ineffective medically focused physician office visit. INDIVIDUALIZED CARE PLANS, and resource allocations, for long term care, durable medical equipment, and behavioral health services, REPLACES the widespread under resourcing and over resourcing that characterizes rule based benefits management.
7 Innovations (cont'd) Elastic nurse practitioner home response capability, to assess and manage new problems, REPLACES physician telephone management, the Ambulance and the Emergency Department. For those in need of behavioral health (BH) services, INTERGRATED BEHAVIORAL HEALTH CLINICIAN ASSESSMENT, individualized care plan development, implementation and management REPLACES inaccessible BH carve out options or inaccessible services.
8 Innovations (cont'd) 24/7 clinical availability and continuity management REPLACES going it alone. Web based EMR support REPLACES absence of clinical information transfer capabilities. Investment in and the creation of a network of Community Based Crisis Stabilization Units that features clinical integration and continuity with providers More appropriate venues of care for 50-70% of Commonwealth Care Alliance s members with Serious Mental Illness than psychiatric hospitals
9 Measures of Success? Significant reductions in hospitalization admissions and days* Commonwealth Care Alliance risk adjusted hospital admissions and days, are 52% of the Medicare Dual eligible FFS experience ( ) Significant reductions in hospital readmissions CMS NCQA Measure: Commonwealth Care Alliance s 2010-risk adjusted 30 day hospital readmission rate =4% vs. 13% of the Medicare Advantage median, >99 th percentile Significant Reduction in Psychiatric admissions Improved Care Outcomes Reduced mortality *Lewin Associates study commissioned by the SNP Alliance of member risk adjusted hospital utilization experience vs. Medicare benchmark
10 Thank You Peggy Johnson, MD Chief of Psychiatry Commonwealth Care Alliance 30 Winter Street Boston, MA x
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
Pushing the Envelope of Population Health
Pushing the Envelope of Population Health Timothy Ferris, MD, MPH Senior Vice President, Population Health Management, Partners HealthCare May 15, 2014 DISCLAIMER: The views and opinions expressed in this
Leveraging EHR to Improve Patient Safety: A Davies Story
Leveraging EHR to Improve Patient Safety: A Davies Story Claudia Colgan, Vice President of Quality Initiatives Bruce Darrow, MD, PhD, Interim Chief Medical Information Officer Jill Kalman, MD, Director
Factors affecting variation in Medicare Advantage plan star ratings. Carlos Zarabozo September 10, 2015
Factors affecting variation in Medicare Advantage plan star ratings Carlos Zarabozo September 10, 2015 Presentation outline Review of Medicare Advantage star rating system and bonus provisions The issues
Associate Chief Financial Officer Commonwealth Care Alliance Boston, MA
Associate Chief Financial Officer Commonwealth Care Alliance Boston, MA Position Specification July 2014 The Summary Commonwealth Care Alliance is seeking an Associate Chief Financial Officer (ACFO) for
ADDENDUM to. Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid
ADDENDUM to Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid Proposal to the Center for Medicare and Medicaid Innovation State Demonstration to Integrate Care
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,
How To Testify On The Medicare Advantage Program
The Medicare Advantage Program and the Role of Private Health Plans in Serving Medicare Beneficiaries by Karen Ignagni President and CEO America s Health Insurance Plans for the House Ways and Means Committee
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
Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs
Idaho Health Home State Plan Amendment Matrix: Summary Overview This matrix outlines key program design features from health home State Plan Amendments (SPAs) approved by the Centers for Medicare & Medicaid
Medicare Advantage special needs plans
C h a p t e r14 Medicare Advantage special needs plans R E C O M M E N D A T I O N S 14-1 The Congress should permanently reauthorize institutional special needs plans. COMMISSIONER VOTES: YES 16 NO 0
Supreme Court upholds the Affordable Care Act in its entirety:
Supreme Court upholds the Affordable Care Act in its entirety: What does this mean for Seniors? The Supreme Court s decision to uphold the Affordable Care Act (ACA) in its entirety is a huge victory for
CMS Innovation Center Improving Care for Complex Patients
CMS Innovation Center Improving Care for Complex Patients ECRI Institute Dr. Patrick Conway, M.D., MSc CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality Director, Center for
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
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
Quick Turnaround with Administrative Health Data
Quick Turnaround with Administrative Health Data Katherine Giuriceo, PhD Research and Rapid Cycle Evaluation Group Center for Medicare and Medicaid Innovation, CMS October 2, 2015 1 Overview Center for
Managed Long Term Care: Options for New York and Examples From Other States
Managed Long Term Care: Options for New York and Examples From Other States Prepared by James M. Verdier Mathematica Policy Research, Inc. for the Medicaid Redesign Team Managed Long Term Care Implementation
An Update on Payment Reform Activities at CMS and How Data Analytics and Rapid-Cycle Evaluation Support Transformation
An Update on Payment Reform Activities at CMS and How Data Analytics and Rapid-Cycle Evaluation Support Transformation William Shrank, MD MSHS Division of Pharmacoepidemiology and Pharmacoeconomics Harvard
Be Careful What You Ask For A Predictive Model That Really Works
Be Careful What You Ask For A Predictive Model That Really Works Rod Christensen, MD President, Allina Health Clinics Cheryl Hermann, RN, MBA Vice President, Clinic Operations & Patient Care Services Karen
Center for Medicare and Medicaid Services. Shari M Ling, MD CMS Deputy Chief Medical Officer. September 11, 2014
Center for Medicare and Medicaid Services Shari M Ling, MD CMS Deputy Chief Medical Officer September 11, 2014 Shaping the future of Aging in Place An understanding of factors that allow people to remain
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
CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS
CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS American Urological Association Quality Improvement Summit
Ohio Update & Overview of States Care Coordination Initiatives
Ohio Update & Overview of States Care Coordination Initiatives Maureen M. Corcoran President Daphne Kackloudis Saneholtz Senior Advisor Vorys Health Care Advisors, LLC Today s Teleseminar Logistics Purpose
Food As Medicine: The Case for Insurance Coverage for Medically- Tailored Food Under the Affordable Care Act
Food As Medicine: The Case for Insurance Coverage for Medically- Tailored Food Under the Affordable Care Act Robert Greenwald Clinical Professor of Law Director, Center for Health Law and Policy InnovaFon
AHCCCS Care Delivery System. Reaching across Arizona to provide comprehensive quality health care for those in need
AHCCCS Care Delivery System 1 GAO Medicaid Spending Report Duals excluded 2009-2011 (No Expansion) 1% of Population = 25% of spend 5% = 50% of spend 25%= 75% of spend Bottom 50% = 8% of spend 2 GAO - Conditions
What is an Accountable Care Organization & Why is it Important to Your Home Infusion Company?
What is an Accountable Care Organization & Why is it Important to Your Home Infusion Company? Lisa Harvey McPherson RN, MBA, MPPM EMHS Vice President Continuum of Care & Chief Advocacy Officer Disclosures
Quality Improvement and Payment Reform
Quality Improvement and Payment Reform Mark McClellan, MD, PhD Senior Fellow and Director, Initiative on Value and Innovation in Health Care Brookings Institution Mark McClellan. All rights reserved. No
Minnesota s Dual Demonstration: Managed care model to promote integration of Medicare and Medicaid
Minnesota s Dual Demonstration: Managed care model to promote integration of Medicare and Medicaid Lauren Siegel Dual Demonstration Project Coordinator Minnesota Department of Human Services National Home
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
Summary of the Final Medicaid Redesign Team (MRT) Report A Plan to Transform The Empire State s Medicaid Program
Summary of the Final Medicaid Redesign Team (MRT) Report A Plan to Transform The Empire State s Medicaid Program May 2012 This document summarizes the key points contained in the MRT final report, A Plan
Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS
Performance Measurement in CMS Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS Mind the Gap: Improving Quality Measures in Accountable Care Systems October
Bellin-ThedaCare Healthcare Partners a Pioneer Accountable Care Organization. George Kerwin President/CEO Bellin Health
Bellin-ThedaCare Healthcare Partners a Pioneer Accountable Care Organization George Kerwin President/CEO Bellin Health Objectives Describe the characteristics of Bellin-ThedaCare Healthcare Partners and
Home Care Association of Washington Conference. MaryAnne Lindeblad, State Medicaid Director Washington Health Care Authority
Home Care Association of Washington Conference MaryAnne Lindeblad, State Medicaid Director Washington Health Care Authority April 25, 2013 Overview Overview of Health Care Authority Public Employees Benefits
Organizational and Financial Integration of Behavioral Health into Accountable Care Organizations
Organizational and Financial Integration of Behavioral Health into Accountable Care Organizations Aricca Van Citters, MS Valerie Lewis, PhD Karen Schoenherr, BA Stephen Bartels, MD, MS ACO adoption is
How To Write A Code Of Conduct
Disclosures Behavioral Health Coding, Contracting and Billing, Part 1 Presented by Mimi Reed, BHSA, CPC A, MCP, MTA, Consultant, SCHA MI Mimi Reed, BHSA, CPC A, MCP, MTA, Consultant, SCHA MI Amy Valimont,
ICRC Study Hall Call:
ICRC Study Hall Call: Improving Coordination of Home Health Services and Durable Medical Equipment for Medicare-Medicaid Enrollees in the Financial Alignment Initiative September 8, 2014 2:00-3:00 PM Eastern
Advanced Payment Models in Medicare and Medicaid Draft May 1, 2015
Advanced Payment Models in Medicare and Medicaid Draft May 1, 2015 Secretary of Health and Human Services (HHS) Burwell recently announced a goal for Medicare of having 30% of fee-for-service (FFS) payments
Medicare Medicaid (Duals) Waiver Members
Ohio Continuity of Care/Transition of Care Requirements During the transition period, change from the existing provider can only occur in the following circumstances: 1. When a mmember requests a change;
What Would Strengthen Medicaid LTSS?
What Would Strengthen Medicaid LTSS? Melanie Bella Director Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 1, 2013 Medicare-Medicaid Coordination Office Section 2602
1115 Medicaid Waiver Programs Section1115 of the Social Security Act allows CMS the authority to approve state demonstration projects that improve care, increase efficiency, and reduce costs related to
Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population
Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population November 18, 2013 Diana Dennett EVP, Global Issues and Counsel America s Health Insurance Plans (AHIP) America
Medicare Basics and Medicare Advantage
Medicare Basics and Medicare Advantage Medicare The federal health insurance program for people age 65 and over, some disabled people under 65 years of age, and people with End-Stage Renal Disease (permanent
THE PRIVATE INSURANCE MARKET: THE INFLUENCE OF NEW PAYMENT AND DELIVERY MODELS. Carmella Bocchino Executive Vice President May 13, 2015
THE PRIVATE INSURANCE MARKET: THE INFLUENCE OF NEW PAYMENT AND DELIVERY MODELS Carmella Bocchino Executive Vice President May 13, 2015 1 Plans Driving a Move Toward Value Value Based Benefit Design Innovative
Medicare accountable care organization (ACO) update
Medicare accountable care organization (ACO) update April 4, 2013 David Glass and Jeff Stensland Today s presentation Background Description of ACO models in Medicare Strengths and weaknesses of ACOs vs.
The Commonwealth of Massachusetts Executive Office of Health and Human Services One Ashburton Place, 11 th Floor Boston, MA 02108
DEVAL L. PATRICK Governor TIMOTHY P. MURRAY Lieutenant Governor The Commonwealth of Massachusetts Executive Office of Health and Human Services One Ashburton Place, 11 th Floor Boston, MA 02108 JUDYANN
The Promise of Regional Data Aggregation
The Promise of Regional Data Aggregation Lessons Learned by the Robert Wood Johnson Foundation s National Program Office for Aligning Forces for Quality 1 Background Measuring and reporting the quality
National Medicare Readmission. Centers for Medicare and Medicare Services
National Medicare Readmission Findings: Recent Data and Trends Office of Information Products and Data Analytics Office of Information Products and Data Analytics Centers for Medicare and Medicare Services
Affordable Care Act Opportunities for the Aging Network
Affordable Care Act Opportunities for the Aging Network The Affordable Care Act (ACA) offers many opportunities for the Aging Network to be full partners in health system reform. These include demonstration
CMS Data Resources. Informing the Affordable Care Act. Jason Petroski, PhD, MPA Director, Division of Survey Management and Data Analysis
CMS Data Resources Informing the Affordable Care Act Jason Petroski, PhD, MPA Director, Division of Survey Management and Data Analysis December 5, 2012 Session Overview Describe Current and Planned Survey
Value Based Care and Healthcare Reform
Value Based Care and Healthcare Reform Dimensions in Cardiac Care November, 2014 Jacqueline Matthews, RN, MS Senior Director, Quality Reporting & Reform Quality and Patient Safety Institute Cleveland Clinic
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:
What is an Accountable Care Organization & Why is it Important to Your Home Infusion Company? Disclosures. Overview 3/10/2015
What is an Accountable Care Organization & Why is it Important to Your Home Infusion Company? Lisa Harvey McPherson RN, MBA, MPPM EMHS Vice President Continuum of Care & Chief Advocacy Officer Disclosures
Payment Reform in Massachusetts: Impact and Opportunities for the Health Care Workforce
Payment Reform in Massachusetts: Impact and Opportunities for the Health Care Workforce Jessica Larochelle July 9, 2014 Overview Forces driving payment and delivery system reform Overview of payment and
Quality Accountable Care Population Health: The Journey Continues
Quality Accountable Care Population Health: The Journey Continues Health Insights April 10, 2014 Doug Hastings 2001 Institute of Medicine 2 An Agenda For Crossing The Chasm Between the health care we have
Risk Adjustment in the Medicare ACO Shared Savings Program
Risk Adjustment in the Medicare ACO Shared Savings Program Presented by: John Kautter Presented at: AcademyHealth Conference Baltimore, MD June 23-25, 2013 RTI International is a trade name of Research
Broad Issues in Quality Measurement: the CMS perspective
Broad Issues in Quality Measurement: the CMS perspective Shari M. Ling, MD Deputy Chief Medical Officer Centers for Medicare & Medicaid Services Workshop on Quality Measurement Developing Evidence-Based
H7833_150304MO01. Information for Care Providers about UnitedHealthcare Connected (Medicare- Medicaid Plan) in Harris County, Texas
H7833_150304MO01 Information for Care Providers about UnitedHealthcare Connected (Medicare- Medicaid Plan) in Harris County, Texas Agenda Connecting Medicare and Medicaid Eligible Members Service Coordination
Medical Home: Next Steps in the Neighborhood. David Kelley MD, MPH Chief Medical Officer Office of Medical Assistance Programs
Medical Home: Next Steps in the Neighborhood David Kelley MD, MPH Chief Medical Officer Office of Medical Assistance Programs Outline Pennsylvania s medical home initiatives RDPS Care Collaboration for
The Affordable Care Act
The Affordable Care Act What does it mean for internists? Joshua Becker MD 10/14/2015 VII. 2015 Reforms and Beyond Payment Penalties under Medicare s Pay-for-Reporting Program Value-Based Payment Modifier
Medicare Advantage special needs plans
O n l i n e A p p e n d i x e s14 Medicare Advantage special needs plans 14-A O n l i n e A p p e n d i x Additional data on Medicare Advantage special needs plans and information on quality TABLE 14 A1
ACOs. ACO Definition. ACO Governance. Stuart B Black MD, FAAN Chief of Neurology Co-Director: Neurosciences Baylor University Medical Center at Dallas
Stuart B Black MD, FAAN Chief of Neurology Co-Director: Neurosciences Baylor University Medical Center at Dallas ACOs ACO Definition CMS definition of ACO Accountable Care Organizations (ACOs) are groups
Technical Note: Comparison of Methodologies between Total Health Care Expenditures and State Health Expenditure Accounts
Center for Health Information and Analysis Technical Note: Comparison of Methodologies between Total Health Care Expenditures and State Health Expenditure Accounts October 2014 Executive Summary This
The Value Quadrant of Healthcare Reform. 2008 Pharos Innovations, LLC. All Rights Reserved.
The Value Quadrant of Healthcare Reform ACOs in PPACA Provider Organizations or networked groups Accountable for quality, cost and overall care of defined population of Medicare FFS benes Key metrics to
Improving Quality And Bending the Cost Curve: Strategies That Work
Improving Quality And Bending the Cost Curve: Strategies That Work Lewis G. Sandy MD SVP, Clinical Advancement, UnitedHealth Group UnitedHealth Center for Health Reform and Modernization AcademyHealth
PSYCHIATRY IN HEALTHCARE REFORM SUMMARY REPORT A REPORT BY AMERICAN PSYCHIATRIC ASSOCIATION BOARD OF TRUSTEES WORK GROUP ON THE ROLE OF
ROLE OF PSYCHIATRY IN HEALTHCARE REFORM SUMMARY REPORT A REPORT BY AMERICAN PSYCHIATRIC ASSOCIATION BOARD OF TRUSTEES WORK GROUP ON THE ROLE OF PSYCHIATRY IN HEALTHCARE REFORM 2014 Role of Psychiatry in
Terry McGeeney, MD MBA, President, CEO of TransforMED
Terry McGeeney, MD MBA, President, CEO of TransforMED Terry McGeeney, MD MBA, President, CEO of TransforMED According to the Future of Family Medicine Report: unless there are changes in the broader healthcare
Care Transitions Training Videoconference December 17, 2009 Questions and Answers
1. Q: Will the transition log be sent to the counties and care systems electronically? A: It will be available on each health plan s Web page. If a website is not available, the plan will send the form
Telehealth services and the Medicare program. Zach Gaumer, Amy Phillips, Ariel Winter, and Jeff Stensland November 5, 2015
Telehealth services and the Medicare program Zach Gaumer, Amy Phillips, Ariel Winter, and Jeff Stensland November 5, 2015 Presentation outline Definition of telehealth services Telehealth services under
Medicare Advantage Star Ratings: Detaching Pay from Performance Douglas Holtz- Eakin, Robert A. Book, & Michael Ramlet May 2012
Medicare Advantage Star Ratings: Detaching Pay from Performance Douglas Holtz- Eakin, Robert A. Book, & Michael Ramlet May 2012 EXECUTIVE SUMMARY Rewarding quality health plans is an admirable goal for
ACCOUNTABLE CARE ORGANIZATION (ACO): SUPPLYING DATA AND ANALYTICS TO DRIVE CARE COORDINATION, ACCOUNTABILITY AND CONSUMER ENGAGEMENT
ACCOUNTABLE CARE ORGANIZATION (ACO): SUPPLYING DATA AND ANALYTICS TO DRIVE CARE COORDINATION, ACCOUNTABILITY AND CONSUMER ENGAGEMENT MESC 2013 STEPHEN B. WALKER, M.D. CHIEF MEDICAL OFFICER METRICS-DRIVEN
Medicaid Health Homes. Integrated Care Conference September 25, 2013
Medicaid Health Homes Integrated Care Conference September 25, 2013 1 Outline Program Background Health Home Overview Objectives Services Eligibility Provider Eligibility Participant Eligibility Health
What is an Accountable Care Organization. Amit Rastogi, MD President/CEO PriMed
What is an Accountable Care Organization Amit Rastogi, MD President/CEO PriMed Goals Why is U.S. healthcare undergoing dramatic change How reimbursement structures are likely to change What is the timeline
907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies.
907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies. RELATES TO: KRS 205.520, 216B.450, 216B.455, 216B.459 STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1),
Telemedicine services. Crisis intervcntion response services, except
Approved: MAY 2 4 2010 ATTACHMENT 3.1 -A Page 54j 4. Consultation with relatives, guardians, friends, employers, treatment providers, and other significant people, in order to change situations and allow
Special Needs Plan Provider Education
Special Needs Plan Provider Education Reviewed September 2014 Learning Goals What is a Special Needs Plan (SNPs) What differentiates a SNP from other MA plans What SNPs are offered by Freedom Health and
Understanding Changes to Medicaid Behavioral Health Care in New York
Understanding Changes to Medicaid Behavioral Health Care in New York Community Based Provider Education September 2015 Presentation Overview What are the Goals for the Medicaid Changes? What is Changing?
Medicaid Health Plans: Adding Value for Beneficiaries and States
Medicaid Health Plans: Adding Value for Beneficiaries and States Medicaid is a program with numerous challenges, both for its beneficiaries and the state and federal government. In comparison to the general
DEPARTMENT OF PSYCHIATRY. 1153 Centre Street Boston, MA 02130
DEPARTMENT OF PSYCHIATRY 1153 Centre Street Boston, MA 02130 Who We Are Brigham and Women s Faulkner Hospital (BWFH) Department of Psychiatry is the largest clinical psychiatry site in the Brigham / Faulkner
Care needs for dual-eligible beneficiaries
C h a p t e r6 Care needs for dual-eligible beneficiaries C H A P T E R 6 Care needs for dual-eligible beneficiaries Chapter summary In this chapter Dual-eligible beneficiaries are eligible for both Medicare
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
Discussion Document of Selected Terms of New Maryland All-Payer Model Educational Materials October 7, 2013 Maryland Health Services Cost Review
Discussion Document of Selected Terms of New Maryland All-Payer Model Educational Materials October 7, 2013 Maryland Health Services Cost Review Commission 1 Agenda I. Answer questions on draft application
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida Medicare Quality Management Program Overview Quality Improvement (QI) Overview At Coventry, we
R. Kendall Smith, Jr., MD, SFHM. 601 NW 22 nd Court Wilton Manors, FL 33311 Phone: (954) 610-381
601 NW 22 nd Court Wilton Manors, FL 33311 Phone: (954) 610-381 PROFESSIONAL SUMMARY I am a hospitalist of 18 years with an extensive background in quality improvement, utilization review, information
MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT
MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 12, 2014 Status: Current Summary of Changes Clarifications: Pg 4, Description, updated
Who Reports NQF 18 NCQA
Who Reports NQF 18 Various providers & health care systems are required and/or incentivized to annually report this clinical measure to payers such as CMS and national quality entities. The next slides
ACOs: Impacting the Past, Present and Future State of Healthcare
ACOs: Impacting the Past, Present and Future State of Healthcare Article By Alan Cudney, RN, CPHQ, PMP, FACHE, Executive Consultant October 2012 What are Accountable Care Organizations? Can they help us
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
Welcome! Medicare Advantage. Elderplan Advantage Institutional Special Needs Plan
Elderplan Advantage Institutional Special Needs Plan 1 Welcome! Goals for today: To give you an overview of Medicare Advantage Works To give you a sense of the role of ISNP in an SNF To provide a description
Ohio Medicaid Health Homes. The Future for Providers and Patients
Ohio Medicaid Health Homes The Future for Providers and Patients Understand Prepare Provide 2012 Annual Conference on Aging Ohio Association of Area Agencies on Aging Making History Medical Reintegration
Future of Health Care: How Do You Fit In? Physician Leadership Institute February 28, 2015 Brian M. McCook, CPA
Future of Health Care: How Do You Fit In? Physician Leadership Institute February 28, 2015 Brian M. McCook, CPA Learning Objectives Industry Transitions Challenges and Changes ACO s Look at the Future
THE EVOLUTION OF CMS PAYMENT MODELS
THE EVOLUTION OF CMS PAYMENT MODELS December 3, 2015 Dayton Benway, Principal AGENDA Legislative Background Payment Model Categories Life Cycle The Models LEGISLATIVE BACKGROUND Medicare Modernization
A predictive analytics platform powered by non-medical staff reduces cost of care among high-utilizing Medicare fee-for-service beneficiaries
A predictive analytics platform powered by non-medical staff reduces cost of care among high-utilizing Medicare fee-for-service beneficiaries Munevar D 1, Drozd E 1, & Ostrovsky A 2 1 Avalere Health, Inc.
UPDATED: NOVEMBER 2009 344.1 RESOURCES THIRD PARTY RESOURCES
UPDATED: NOVEMBER 2009 344.1 NOTE: Enrollment in Medicare is a condition of eligibility for Medicaid. Beginning in 2006, persons entitled to Part A and/or enrolled in Part B are eligible for the prescription
What this means for Idaho?
What this means for Idaho? Why now? The 2011 Idaho Legislature approved the Medicaid Cost Containment and Health Care Improvement Act : The current fee-for-service health care delivery system of payment
Issue Brief. Winter 2012
Strategies for Incorporating Telehealth based Care Coordination and Management Solutions into Programs to Integrate Care for Dual Eligibles Telehealth based care coordination and management is a successful
Oct 5, 2014 John McCarthy Medicaid Director
Ohio Medicaid Overview Oct 5, 2014 John McCarthy Medicaid Director Medicaid Overview Medicaid is Ohio s largest health payer 83,000 active providers, hospitals, nursing homes and other providers care for
Private Fee-For-Service -----Provider Questions and Answers
Private Fee-For-Service -----Provider Questions and Answers 1. What qualifications must a health care provider have in order to be eligible to furnish services to Medicare beneficiaries who are enrolled
Medicare Advantage Stars: Are the Grades Fair?
Douglas Holtz-Eakin Conor Ryan July 16, 2015 Medicare Advantage Stars: Are the Grades Fair? Executive Summary Medicare Advantage (MA) offers seniors a one-stop option for hospital care, outpatient physician
San Diego County Managed Care Behavioral Health Overview. Presented by George Scolari, Chair Healthy San Diego Behavioral Health Work Group
San Diego County Managed Care Behavioral Health Overview Presented by George Scolari, Chair Healthy San Diego Behavioral Health Work Group 1 Healthy San Diego Overview Healthy San Diego is the collaborative
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