Special Needs Plans. A Platform and Strategy for Quality and Control Provider Sponsored
|
|
|
- Preston Lewis
- 8 years ago
- Views:
Transcription
1 A Platform and Strategy for Quality and Control Provider Sponsored Special Needs Plans Alicia Heazlitt, VP, Signature HealthCARE Will Saunders, CEO, AllyAlign Health
2 Agenda Agenda Items Introductions The Evolution of Managed Care A Provider Sponsored Special Needs Plan - Signature Advantage Development, Approval and Launch - Model of Care and Keys to Success Discussion 2
3 Duals The Challenge and Opportunity Medicaid LTSS: Stepping stone to duals integration Ability to drive mandatory enrollment Savings only feasible from Medicare spend Formulator States: States currently formulating their strategy for managed care Vehicle of choice will be D SNPs 3
4 Enrollment Status Enrolment By Region and Type Opt-Out By Region and Type Payer View Limited enrollment Significant prescriptive requirements Provider push back Hospital systems LTC provider engagement Provider View Administrative burden Payment delays Authorization requirements State View CMS driven program Significant push back from patients, providers and advocates Prefer flexibility and control 4
5 Market Dynamics and Evolution Lack of Provider Control and Input Third party (MCO, ACO, convener) controls patient and premium $ Emphasis is on payment methods, not quality SNF doesn t own data or influence protocols/care patterns Administrative disruption as large a threat as competitive pressures 5
6 Market Dynamics and Evolution Focus on episodic post acute models will intensify Medicare Advantage penetration will continue to increase Duals 2.0 is rapidly emerging o Demonstrations have languished and will evolve o CMS will soon issue guidance expanding the ACO model to cover dual eligibles Burdensome CMS/State regulations Lack of Provider Engagement Payer Challenges o CMS/State will anoint D SNPs in non Duals states and in post demonstration period Provider Sponsored Organizations qualify 6
7 How does an Operator Win Provider Owned Medicare Advantage Special Needs Plan Market Dynamics o Model o o o Outcomes o o o Appropriate for Formulator states where Duals have not been enrolled into 3rd party MCOs; and for aftermath of initial Duals demonstrations Contract directly with CMS to operate a Special Needs Plan for nursing home eligible population Significant investment: HMO license, provider network, MA PD, effective Model of Care, etc. Take risk for total cost of care for patient population Accept risk and enjoy reward for investments in quality and cost efficiencies Pre-empt 3rd party managed care (MCOs and hospital driven ACOs): offer an actionable, constructive alternative for state policy makers Move up the value chain in relationships with payers, ACOs etc. Ultimate strategy: own and operate the risk bearing entity (D SNP) that contracts with the State/CMS for the duals/nursing home eligible population 7
8 8
9 Benefit Design SNF PCP Dental Vision Non ER Transport Hearing Podiatry Over-the-counter drug card $0/day for days No prior hospital stay required. $0 copay $0 copay for preventive & comprehensive. $250 combined limit per year $0 copay for exams and hardware. $150 hardware limit per year $0 copayment 24 one-way trip limit/year $0 copay for exams, hearing aids $800 limit per year $0 copay for non-medicare covered services 6 supplemental visits per year $15/month
10
11
12 Economic and Joint Venture Model Signature HealthCARE owners and AllyAlign contribute to form Plan and share proportional risk (i.e. additional capital investment) and reward (i.e., profit) going forward Provider earns revenue in four ways: Medicare FFS payments Facility Nurse Practitioner services Value-based incentives (i.e., gain-share) for facility and NP Reimbursement for administrative services provided to the Plan Share of Plan s profit Note that Medicaid payments (if applicable) are unaffected and continue to be paid as they are today
13 Sample PMPM View * * Key Assumptions 450 Hospital Admits/1000 1/3 of prevented admissions result in incremental skilled stay Optimized Risk Score *
14 Economic and Joint Venture Model
15 Special Needs Plan Construct
16 Keys to Success Outcome: Lower ER Visits/Hospitalizations Increased SNF utilization, payment for appropriate services Incented ICT team members who compliantly gain share in profits of plan Engaged, informed family members Greater retention and rewards for key facility staff Satisfied residents Investments benefit non Plan related population (short stay SNF patients) 16
17 A cloud based, configurable platform purpose built to support provider sponsored Special Needs Plans. 17
18 Model of Care: Integrated Care Team Focus Empowered Integrated Care Team focused on: Constantly assessing and risk stratifying patient population Implementing and monitoring a customized Plan of Care Real time referrals and authorization for: Skilling in place, fully utilizing SNF resources Necessary coordinated care in all settings and amongst necessary specialists Additional reimbursement for appropriate services (e.g. mobile imaging, off hours hours telemedicine) Establishing accountability amongst ICT team members for care elements Utilizing evidence-based guidelines Supported by a care coordination platform that integrates data and transmits actionable alerts to: Streamline line assessment process that automatically flows into a plan of care Continuously follow and update Pan of Care Identify service duplication Improve medication compliance and regimens Conducting family counseling
19 Model of Care: Integrated Care Team Focus What we try to avoid: Prior authorization of services reviewed and requested by ICT Retrospective utilization management of ICT decisions Retrospective denial of services Medical necessity reviews of services referred/requested by ICT Flurry of non actionable alerts and messages Unnecessary services requested by frustrated family members
20 Key Application Elements Application Element HMO License AllyAlign Fully Supported AllyAlign Supported with Partner Input AllyAlign Foundation for Success Fully developed NAIC/UCAA Template Timing Initiate: Sept 15 Fund: Feb 16 Comment Financial disclosure requirements of ultimate controlling party Model of Care AAH Model of Care: Perfect Score from NCQA/CMS; full 3 year approval Review: Oct Dec File: Feb 16 Must customize for facility initiatives and programs Provider Network National alliances (hospital; physician, transplant, lab, dme etc); Mapping and analytic tools that mimic CMS criteria Initiate: ASAP File: Feb 16 Biggest challenge will require facility-led introductions to local providers MA PD Turn Key Fully Compliant PBM File in Feb 16 Fully developed solution Application Elements Fully Developed and Approved File in Feb 16 Compliance Plans, Quality Improvement Plans etc. 20
21 Application Timeline
22 Questions & Discussion Will Saunders Founder & CEO (804)
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
2016 Medicare Advantage Special Needs Plans (SNP) Full Dual Medicare & Medicaid Maricopa County
2016 Medicare Advantage Special Needs Plans (SNP) Full Dual Medicare & Medicaid Maricopa County Special Needs Plans for Dual Eligible beneficiaries are an HMO plan that limits their membership to people
Medicare Advantage Funding Cuts and the Impact on Beneficiary Value
Medicare Advantage Funding Cuts and the Impact on Beneficiary Value Commissioned by Better Medicare Alliance Prepared by: Milliman, Inc. Brett L. Swanson, FSA, MAAA Consulting Actuary Eric P. Goetsch,
NetworkCares (PPO SNP) 2016 Model of Care Training. H5215_360r1_092714 NHIC 12/2015 m-cnm-ncprovpres-1215
NetworkCares (PPO SNP) 2016 Model of Care Training H5215_360r1_092714 NHIC 12/2015 m-cnm-ncprovpres-1215 Introduction This course is offered to meet the CMS regulatory requirements for Model of Care Training
Minnesota Senior Health Options (MSHO) (Summary by Brenda Schmitthenner)
Minnesota Senior Health Options (MSHO) (Summary by Brenda Schmitthenner) The Minnesota Dept. of Health Services has developed a program called the Minnesota Senior Health Options (MSHO) which combines
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
Medicare Shared Savings Program Final Rule
Healthcare Committee Medicare Shared Savings Program Final Rule On June 9, 2015, the Centers for Medicare & Medicaid Services ( CMS ) published a final rule that, according to the agency, will update and
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
HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS. April 10, 2014
HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS April 10, 2014 1 MARKETPLACE UPDATE 2 MARKETPLACE - ESSENTIAL HEALTH BENEFITS 3 MARKETPLACE - METAL LEVELS 4 WHAT IS THE HEALTH INSURANCE MARKETPLACE
Napa County. Medicare Advantage Plans. (Medicare Part C Plans) Compliments of HICAP. (Health Insurance Counseling and Advocacy Program)
2015 Napa County Medicare Advantage Plans (Medicare Part C Plans) HICAP Volunteer Counselors are available to help compare health plans in an objective and unbiased manner. They can help consumers understand
GAO MEDICARE ADVANTAGE. Relationship between Benefit Package Designs and Plans Average Beneficiary Health Status. Report to Congressional Requesters
GAO United States Government Accountability Office Report to Congressional Requesters April 2010 MEDICARE ADVANTAGE Relationship between Benefit Package Designs and Plans Average Beneficiary Health Status
Accountability and Innovation in Care Delivery Models
Accountability and Innovation in Care Delivery Models Lisa McDonnel Senior Vice President, Network Strategy & Innovation, United Healthcare November 6, 2015 Today s discussion topics Vision Our strategic
Managed Care for Duals
Managed Care for Duals Jim Schultz, MD, MBA Chief Medical Officer, CCC Gary Rotto Director of Health Policy March 6, 2013 Patients with both Medicare and Medicaid 10 million in US, 1.2 million in California
Medicare Shared Savings Program: Accountable Care Organizations. Centers for Medicare and Medicaid Services Final Rule Provisions
Medicare Shared Savings Program: Accountable Care Organizations Centers for Medicare and Medicaid Services Final Rule Provisions The Centers for Medicare and Medicaid Services (CMS) published a final rule
Understanding your. Medicare options. Medicare Made Clear TM. Get Answers Series. Y0066_120629_084915 CMS Accepted
Understanding your Medicare options. Medicare Made Clear TM Get Answers Series Y0066_120629_084915 CMS Accepted learning about Medicare Choices. Eligibility Coverage options When to enroll Next steps and
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
FACT SHEET Medicare Advantage (Part C): An Overview (C-001) p. 1 of 5
FACT SHEET Medicare Advantage (Part C): An Overview (C-001) p. 1 of 5 Medicare Advantage (Part C): An Overview Medicare Advantage is also known as Medicare Part C. A Medicare Advantage (MA) plan is an
NH Medicaid Managed Care Supplemental Issue
Empowering and informing families and professionals caring for children with special health care needs and disabilities from birth to adulthood. NH Medicaid Managed Care Supplemental Issue In 2011 the
What is a Medicare Advantage Plan?
CENTERS FOR MEDICARE & MEDICAID SERVICES What is a Medicare Advantage Plan? A Medicare Advantage Plan (like an HMO or PPO) is a way to get your Medicare benefits. Unlike Original Medicare, in which the
Annual Notice of Changes for 2015
Cigna-HealthSpring Advantage (HMO) offered by Cigna-HealthSpring Annual Notice of Changes for 2015 You are currently enrolled as a member of Cigna-HealthSpring Advantage (HMO). Next year, there will be
How Health Reform Will Affect Health Care Quality and the Delivery of Services
Fact Sheet AARP Public Policy Institute How Health Reform Will Affect Health Care Quality and the Delivery of Services The recently enacted Affordable Care Act contains provisions to improve health care
Succeeding In A Managed Care Market: Options, Tools & Techniques
Succeeding In A Managed Care Market: Options, Tools & Techniques Steven E. Ramsland, EdD, Senior Associate, OPEN MINDS Howard Shiffman, Senior Associate, OPEN MINDS September 24, 2014 Sponsored By: The
Arizona State Retirement System Plan Benefit Information for Medicare Eligible Members
Arizona State Retirement System Plan Benefit Information for Medicare Eligible Members Benefits Effective January 1, 2012 UHAZ12HM3349753_000 H0303_110818_013543 Summary of the UnitedHealthcare plans
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
Accountable Care and Value Based Payments 101: Government Programs Update
1 Accountable Care and Value Based Payments 101: Government Programs Update June 24 th, 2014 Dave Neiman, FSA, MAAA Senior Consulting Actuary DaveN@Wakely.com (720) 226-9806 2 Caveats Opinions expressed
Banner Health Network Pioneer ACO - Physician Toolkit
& The Banner Health Network, an AIP and Banner Health partnership, present the Banner Health Network Pioneer ACO - Physician Toolkit This BHN Pioneer ACO Physician Toolkit has been developed to provide
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
You have from October 15 until December 7, to make changes to your Medicare coverage for next year.
UPMC for Life HMO (HMO) offered by UPMC Health Plan Annual Notice of Changes for 2015 You are currently enrolled as a member of UPMC for Life HMO. Next year, there will be some changes to the plan s costs
Ohio s strategy to enroll primary care practices in the federal Comprehensive Primary Care Plus (CPC+) Program
Ohio s strategy to enroll primary care practices in the federal Comprehensive Primary Care Plus (CPC+) Program Greg Moody, Director Governor s Office of Health Transformation Webinar for Primary Care Practices
Health Care Reform Update January 2012 MG76120 0212 LILLY USA, LLC. ALL RIGHTS RESERVED
Health Care Reform Update January 2012 Disclaimer This presentation is for educational purposes only. It is not a complete analysis of the material contained herein. Before taking any action on the issues
WHEN YOU HAVE MEDICAID AND OTHER INSURANCE
WHEN YOU HAVE MEDICAID AND OTHER INSURANCE Balance Billing, Choosing Providers and Other Advice on Third Party Liability (TPL) A guide to understanding health coverage in New Jersey if you have Medicaid
The Home Health Pay-for-Performance Demonstration
The Home Health Pay-for-Performance Demonstration Demonstration Overview and Terms & Conditions of Participation Centers for Medicare & Medicaid Services Office of Research, Development, and Information
MEDICARE ADVANTAGE HEALTH PLAN OPTIONS
MODULE 5: MEDICARE ADVANTAGE HEALTH PLAN OPTIONS Objectives Below are the topics covered in Module 5, Medicare Advantage (MA) Health Plan Options. This module will help to ensure that HIICAP counselors
It s Time for Medicare
It s Time for Medicare med-waageinbook-1214 Medicare What you need to know. You re turning 65. Or you re already 65 and getting ready to retire and lose your healthcare coverage. You re almost ready for
State Retiree Medicare Advantage Plans
State Retiree Medicare Advantage Plans October/November 2015 Copyright 2013 by The Segal Group, Inc. All rights reserved. Your 2016 Retiree Benefits www.cms.illinois.gov/thetrail 2 Eligibility Who is Required
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
7/31/2014. Medicare Advantage: Time to Re-examine Your Engagement Strategy. Avalere Health. Eric Hammelman, CFA. Overview
Medicare Advantage: Time to Re-examine Your Engagement Strategy July 2014 avalerehealth.net Avalere Health Avalere Health delivers research, analysis, insight & strategy to leaders in healthcare policy
Annual Notice of Changes for 2015
Cigna HealthSpring Premier (HMO POS) offered by Cigna HealthSpring Annual Notice of Changes for 2015 You are currently enrolled as a member of Cigna HealthSpring Premier (HMO POS). Next year, there will
Reforming Medicare s benefit design. Julie Lee, Scott Harrison, and Joan Sokolovsky March 8, 2012
Reforming Medicare s benefit design Julie Lee, Scott Harrison, and Joan Sokolovsky March 8, 2012 Outline of today s presentation Policy objectives Key design issues Illustrative benefit package With and
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
Annual Notice of Changes for 2015
Cigna HealthSpring Preferred (HMO) offered by Cigna HealthSpring Annual Notice of Changes for 2015 You are currently enrolled as a member of Cigna HealthSpring Preferred (HMO). Next year, there will be
Gateway Health Medicare Assured RubySM (HMO SNP) $6,700 out-of-pocket limit for Medicare-covered services. No No No No. Days 1-6: $0 or $225 copay per
Assured RubySM (HMO Premium $0 monthly plan $0 - $33.90 monthly plan Assured GoldSM (HMO $12.40 - $46.30 monthly plan $43.90 - $77.80 monthly plan In Network Maximum Out-of-Pocket $3,400 out-of-pocket
ACO s as Private Label Insurance Products
ACO s as Private Label Insurance Products Creating Value for Plan Sponsors Continuing Education: November 19, 2013 Clarence Williams Vice President Client Strategy Accountable Care Solutions Today s discussion
Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency
Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency Julie Lewis Director of Health Policy Dartmouth Institute for Health Policy and Clinical Practice
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
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
Medicare Resource Guide
Medicare Resource Guide Patient Name Dear Patient, Please take the time to read the following sections of this brochure as noted by your healthcare provider. These different components of Medicare deal
Medicare & UC Medical Benefits
Medicare & UC Medical Benefits UCSB Health Care Facilitator Program Laura Morgan 893-4201 UC Retirement Administration Service Center (RASC) 1-800-888-8267 This presentation is intended for communication
Frequently Asked Questions and Answers: Managed Care Organizations and HCS/TxHmL Program Providers
Frequently Asked Questions and Answers: Managed Care Organizations and HCS/TxHmL Program Providers Pharmacy/Medication Related Questions: 1) Question: After the initial transition pre-authorization period,
Medicare Advantage Program. Michael Taylor, PhD Medicare Advantage Manager
Medicare Advantage Program Michael Taylor, PhD Medicare Advantage Manager Objectives General Overview of Medicare Advantage CMS 5 Star Ratings Medicare Part C & D Audit Process Coping with Contract Terminations
Chapter 16 Restricted Recipient Program
Chapter 16 Restricted Recipient Program Program Overview The Restricted Recipient Program (RRP) is a program developed by the Minnesota Department of Human Services for recipients who have failed to comply
The Alphabet Soup of Managed Care Organizations: Provider Perspective
Session 16: The Alphabet Soup of Managed Care Organizations: Provider Perspective Society of Actuaries 1997 Annual Meeting Monday, October 27 10:30 a.m. - 12:00 noon Timothy M. Ross $ MSO HCFA PB M CISN
Annual Notice of Changes for 2015
Coventry Advantage (no drug) (HMO) offered by Coventry Health Care of Missouri, Inc. Annual Notice of Changes for 2015 You are currently enrolled as a member of Coventry Advantage (no drug) (HMO). Next
Managed Care 101: Understanding the Basics and Opportunities for Partnership. Bruce A. Chernof, M.D. President & CEO
TSF Webinar January 8, 2013 Managed Care 101: Understanding the Basics and Opportunities for Partnership Bruce A. Chernof, M.D. President & CEO Presentation Overview: Managed Care 101 Background Goals
Choose the Medicare Advantage Plan That s Right for You
Choose the Medicare Advantage Plan That s Right for You Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Other pharmacies/physicians/providers are available
10/7/2015. Orthopedics in the Value-Based Environment. Financiers of Health Care are Becoming More Active. ACOs and Beyond.
Orthopedics in the Value-Based Environment ACOs and Beyond October 9, 2015 Accountable Care Solutions from Aetna Aetna Inc. Financiers of Health Care are Becoming More Active 2 Instead of payment that
Health Partners Plans Provider Manual Health Partners Medicare Benefits Summary
5 Health Partners Plans Provider Manual Health Partners Medicare Benefits Summary Purpose: This chapter provides a benefit summary for Health Partners Medicare members, by plan. Topics: Health Partners
July 20, 2015. Dear Colleague:
July 20, 2015 Dear Colleague: On May 29, 2015, the Department of Human Services released a request for information (RFI) to help guide us as we plan for the release of a new procurement for the provision
What s Medicare? What are the different parts of Medicare?
Revised June 2014 What s Medicare? Medicare is health insurance for: People 65 or older People under 65 with certain disabilities People of any age with End-Stage Renal Disease (ESRD) (permanent kidney
Superior HealthPlan. Assisted Living, Residential Care and Adult Foster Care SHP_2014635
Superior HealthPlan Assisted Living, Residential Care and Adult Foster Care SHP_2014635 Who is Superior HealthPlan? Superior HealthPlan is a subsidiary of Centene Management Corporation, a Fortune 500
E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences
Accountable Care Organizations and You E. Christopher Ellison, MD, F.A.C.S Senior Associate Vice President for Health Sciences CEO, OSU Faculty Group Practice Chair, Department of Surgery Ohio State University
Accountable Care Organization Workgroup Glossary
Accountable Care Organization Workgroup Glossary Accountable care organization (ACO) a group of coordinated health care providers that care for all or some of the health care needs of a defined population.
Health Partners Plans Provider Manual Health Partners Plans Medicare Benefits Summary
5 Health Partners Plans Provider Manual Health Partners Plans Medicare Benefits Summary Purpose: This chapter provides a benefit summary for Health Partners Plans Medicare members, by plan. Topics: Health
Assembling the Puzzle. Welcome!
Assembling the Puzzle Welcome! Thank you for joining us. The webinar will start momentarily. If you have not yet dialed in to the audio portion of the webinar, please click on Info Tab above, and follow
Health Pricing Boot Camp August 10-11, 2009 Session 1b: Medicare Coverage for the Aged and Disabled
Health Pricing Boot Camp August 10-11, 2009 Session 1b: Medicare Coverage for the Aged and Disabled Charles P. Miller, FSA, MAAA Introductions Daniel W. Bailey, FSA, MAAA Ingenix Consulting Russell D.
Revenue Cycle Management + Value-Based Medicine
Revenue Cycle Management + Value-Based Medicine Presented by: Justin T. Barnes, VP of Industry & Government Affairs Bryan Koch, VP of Revenue Cycle Solutions Safe harbor Safe harbor statement under the
CMS-1461-P Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations
February 6, 2015 Ms. Marilyn Tavenner Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services 7500 Security Boulevard Baltimore, Maryland 21244 RE: CMS-1461-P Medicare
Accountable Care Organizations: What Are They and Why Should I Care?
Accountable Care Organizations: What Are They and Why Should I Care? Adrienne Green, MD Associate Chief Medical Officer, UCSF Medical Center Ami Parekh, MD, JD Med. Director, Health System Innovation,
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
California Ironworkers Field Welfare Plan 1/1/2014 Open Enrollment Benefit Plan Comparison Non-Medicare Retired Participants Residing in Nevada
Non- Choice of Providers Calendar Year Deductible *The Fund s Calendar Year Deductible is never waived. However, some services are not subject to the Deductible. If you live in Nevada, your network of
Medicare s fee-for-service benefit design. Julie Lee, Joan Sokolovsky, and Scott Harrison April 7, 2011
Medicare s fee-for-service benefit design Julie Lee, Joan Sokolovsky, and Scott Harrison April 7, 2011 Context for discussion of Medicare s benefit design Fee-for-service (FFS) benefit design leads to
Health Care Policy Legislative Oversight Committee
Health Care Policy Legislative Oversight Committee Mikki Stier, Medicaid Director November 3, 2015 Goal/Design MCO Status Member Update Provider Update Oversight MCO financing Administrative Rules Overview
Medicare 101 Guide Your Guide to Medicare Basics
Medicare 101 Guide Your Guide to Medicare Basics Y0013_16_MEDGUI Accepted 11232015 bcbstmedicare.com Get More from Your Medicare This guide helps you understand how Medicare s different parts work and
ANNUAL NOTICE OF CHANGES FOR 2016
Cigna-HealthSpring Preferred (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna-HealthSpring Preferred (HMO). Next year, there will be
Tribute Health Plan of Arkansas (HMO SNP), a Superior Select product.
Tribute Health Plan of Arkansas (HMO SNP), a Superior Select product. Tribute Health Plan of Arkansas HMO SNP is a Health plan with a Medicare contract. Enrollment in Tribute Health Plan of Arkansas HMO
RETIRED LABORERS HEALTH AND WELFARE PLAN - COMPARISON OF BENEFITS - EFFECTIVE SEPTEMBER 1, 2015 LABORERS
When You Can Change Plans Type of Plan Geographical Area Covered Choice of Physicians Specialized Care: In-Network Outside Network Out-of-Area Care Claim Forms Annual Deductible RETIRED HEALTH AND WELFARE
What s a Medicare Advantage Plan?
Revised April 2015 What s a Medicare Advantage Plan? You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO). If you have Original Medicare, the
2016 Riverside Medical Clinic Contracted Medicare Advantage Health Plan Benefit Comparison
Riverside Medical Clinic Contracted Medicare Advantage Health Plan AARP Medicare Complete Plan 1 [Secure Horizons] 1-877-596-3258 Anthem MediBlue Select 1-800-797-6438 Health Net Healthy Heart ** 1-800-
Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team
Applying ACO Principles to a Pediatric Population UH Rainbow Care Connection: Transforming Pediatric Ambulatory Care with a Physician Extension Team Ethan Chernin, MBA Director 1 Objectives Understand
Sharing EHR data between NF, MD, & LTC pharmacy using CMS standard messages
Sharing EHR data between NF, MD, & LTC pharmacy using CMS standard messages Christopher Laxton, CAE Shelly Spiro, RPh, FASCP Rod Baird Executive Director Executive Director President AMDA The Society for
Service AvMed Cigna Leon Cares Humana HMO Humana PPO UnitedHealthcare. Out-of- Network
2016 Medicare Advantage Plans Comparison Chart This comparison chart is a side-by-side representation of services offered through the AvMed, Cigna, UHC, and Humana Medicare Advantage Plans for both in-network
Health Insurance Exchange & Network Management Solutions
Health Insurance Exchange & Network Management Solutions Mike Flanagan AVP, Product Management June 19, 2013 Today s Presenter Mike Flanagan Associate Vice President of Product Management McKesson Health
Medicare Accountable Care Organizations: What it s about
Medicare Accountable Care Organizations: What it s about Gail Albertson, MD Associate Professor of Medicine Chief Operating Officer, UPI Medicare Accountable Care Under the Medicare Shared Savings Program
Reforming and restructuring the health care delivery system
Reforming and restructuring the health care delivery system Are Accountable Care Organizations and bundling the solution? Prepared by: Dan Head, Principal, RSM US LLP dan.head@rsmus.com, +1 703 336 6536
Choosing a Medicare advantage Plan
Choosing a Medicare advantage Plan Medicare Made Clear TM Get Answers Series Look inside to: understand Medicare advantage (Part C) plans find out about cost sharing learn how to enroll Y0066_140417_151113
Update on Medicare accountable care organizations (ACOs): September 11, 2014 David Glass, Jeff Stensland
Update on Medicare accountable care organizations (ACOs): September 11, 2014 David Glass, Jeff Stensland Today s presentation Background Medicare shared savings program (MSSP): status, 1 st year performance
A Conversation About Medicare Part A, B, C and D
Please take this moment to convert the display to Full Screen A Conversation About Medicare Part A, B, C and D www..com A Conversation About Medicare Part A, B, C and D www.healthcaremedicalpharmaceuticaldirectory.com
Testimony to the Senate Committee on Veterans Affairs and Health S. B. 739. February 27, 2014. What is an Accountable Care Organization or ACO?
Testimony to the Senate Committee on Veterans Affairs and Health S. B. 739 Professor Sidney D. Watson Center for Health Law Studies Saint Louis University School of Law February 27, 2014 My name is Sidney
WHAT S DRIVING GROWTH IN YOUR PLAN
WHAT S DRIVING GROWTH IN YOUR PLAN Where are new members coming from? Enrollment in Medicare Advantage (MA) plans continues to grow do not miss out on what is fueling this growth. It is not just about
What s Medicare? What are the different parts of Medicare?
Revised June 2015 What s Medicare? Medicare is health insurance for: People 65 or older People under 65 with certain disabilities People of any age with End-Stage Renal Disease (ESRD) (permanent kidney
2016 Retiree Open Enrollment Benefits Briefing Non Medicare
2016 Retiree Open Enrollment Benefits Briefing Non Medicare October 28: Bankhead Theater, Livermore October 29: The Grand Theater, Tracy LLNL-PRES-678554 This work was performed under the auspices of the
ANNUAL NOTICE OF CHANGES FOR 2016
Cigna-HealthSpring Traditions (HMO SNP) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna-HealthSpring Traditions (HMO SNP). Next year, there
Medicare. What you need to know. Choose the plan that s right for you GNHH2ZTHH_15
Medicare What you need to know Choose the plan that s right for you GNHH2ZTHH_15 Choosing a Medicare plan is a lot like buying a car. There are lots of options to consider. And what s right for you may
Humana Medicare Advantage and Prescription Drug Plans
2015 Presentation Humana Medicare Advantage and Prescription Drug Plans Y0040_SPM_SPRE_MAPD_15 Approved GNHH31KHH_15 Let s talk about... Are you eligible? Choosing the right Humana plan for you Your Medicare
Helping you choose the Medicare coverage that best meets your healthcare needs.
Plan Selection Service Allsup Experts are Ready to Help The process of finding the Medicare plan that works best for you can be time-consuming and overwhelming without sufficient guidance. As trusted experts
Things you need to know about Medicare.
Things you need to know about Medicare. 1 2 3 1OPTION Original Medicare We re here to help. Approaching 65 is an important milestone in life, and becoming eligible for Medicare is part of that. Whether
ANNUAL NOTICE OF CHANGES FOR 2016
Cigna HealthSpring TotalCare SMS (HMO SNP) offered by Cigna HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna HealthSpring TotalCare SMS (HMO SNP). Next year,
Are You a Hospital Inpatient or Outpatient?
Are You a Hospital Inpatient or Outpatient? If You Have Medicare Ask! Revised May 2014 Did you know that even if you stay in a hospital overnight, you might still be considered an outpatient? Your hospital
Prescription drugs are a critical component of health care. Because of the role of drugs in treating conditions, it is important that Medicare ensures that its beneficiaries have access to appropriate
Care Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs. Today s Discussion
Care Coordination and Contracting Entities: The CHC Perspective on IPAs and ACOs Ohio Association of Community Health Centers June 2014 Contact Us Andrew Principe PO Box 410221, Cambridge, MA 02141 P.