Special Needs BasicCare

Transcription

1 Special Needs BasicCare 1

2 FirstPlan Blue Basic Core Principals Nurture and Support Relationships Empower Self-Determination Promote Equity and Flexibility Embrace Cultural Diversity Ensure Comprehension Deliver Quality, Relevant Health Care FirstPlan Blue Service Area The service area for FirstPlan Blue includes the following counties: Carlton Cook Lake Koochiching St. Louis 2

3 Why FirstPlan Blue? FirstPlan Blue is a local choice for eligible members We live and work in the communities we serve We answer our own phones - You get a real person when you call customer service - There is no phone tree High customer satisfaction Long history of serving people on public programs FirstPlan Blue Network FirstPlan has a large regional network -Direct Access (No Referrals) As an affiliate of Blue Cross Blue Shield and Blue Plus of Minnesota: -We have access to a large state wide network coordinated through FirstPlan Nationwide network of specialists through BlueCard program -FirstPlan would coordinate these services in partnership with the enrollee and their treating provider. 3

4 FirstPlan Blue Network Dental Network -Largest public programs network in Minnesota Pharmacy Network -Large National Network Medical Home Enrollees choose a Clinic -If a clinic is not chosen then FirstPlan will assign a Primary Care Clinic based on geographical area -Enrollees may change their Primary Care Clinic at anytime -Enrollees have direct access to FirstPlan Blue network providers -Referrals are not required to see FirstPlan Blue network providers including specialists 4

5 Care Model Care Coordinator Assigned upon enrollment -Registered Nurses experienced in the disability field Welcome call within 10 days to schedule a face to face assessment to develop a individualized care plan based on enrollee needs and wants If the enrollee is all ready receiving waivered services the care plan will be coordinated with the county case manager. If they are not receiving waivered services and appear to be at risk for institutional placement the county will be contacted to complete a long term care consultation (LTCC). Enrollees receiving private duty nursing and personal care services paid through fee-for-service, the care coordinator will coordinate these services with the Basic covered services. It is the care coordinator s role to facilitate access to healthcare services regardless of payor source. Intended to create a One-stop-shop for enrollees in accessing and navigating healthcare services FirstPlan Blue Basic Care Coordination The goals of the FirstPlan Blue Basic Care Coordination program are to: Maximize member s health status and functional independence Facilitate member s ability to live in the least restrictive environment Educate members/caregivers about their condition Support and encourage individual accountability for health and wellness (selfcare management) Help members/families coordinate their needs and navigate healthcare services in across primary, acute, and long-term care settings Facilitate primary care visits and increase assessment for preventive care and early intervention to improve health outcomes The care coordinator is not intended to replace existent social, vocational, and residential support relationships. Rather, the role is to coordinate their medical/health care with other services and supports. 5

6 Value Adds FirstHelp -Nurse Advice Line 24/7 FirstPath -Comprehensive Disease Management Prenatal Care Support Program FirstComplements -Discounts on wellness services and products Dental Care Coordination Accordant Care -Rare disease management Blue Print for Health -Stop-smoking program Health A-Z First Ride Transportation FirstPlan Blue Basic members have transportation to and from any covered medical appointment Set up at least 5 days in advance if possible Need member ID, doctor name and address, date and time of appointment Wide range of transportation alternatives for members dependent upon client need If able to ride the bus, Members will be given a bus pass to go to and from Medical appointments, but also be able to use that bus pass during the month for their own personal use. 6

7 Interpreter Services Over the phone interpretation Language Line Services FirstPlan Blue TTY Phone Number In person interpretation/translation services Call FirstPlan Customer Service to arrange Kim Tong Translation Services Contact Numbers Customer Service: or Ryan Noyes Public Programs Relations Coordinator

8 Questions Thank you 8