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Indiana Enrollment Broker Prepared for

IHCP Provider Workshop

October 19, 2010

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Overview

MAXIMUS Services and Responsibilities Hoosier Healthwise Indiana Care Select Healthy Indiana Plan (HIP) Quality Assurance and Performance Monitoring

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MAXIMUS

MAXIMUS, Inc. – parent company is headquartered in Reston Virginia

Ninety-Three (93) program years of EB experience Service 12 states representing over 60% of the nation’s Medicaid

consumers Considerable experience across the company in serving all types of

consumers including persons with disabilities Flexible, robust data systems and state of the art telephony Purdue and ISO certified call centers and enrollment projects Center for Health Literacy providing support to develop appropriate

member materials and translation services

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Project Operations Staffing

Key staff have IN EB-specific expertise & experience to continue success of current EB program

• Sharon Reynolds, Project Manager

• Natalie Smith, Operations Manager

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Services and Responsibilities

Support all Indiana managed care and care management programs• Hoosier Healthwise, Care Select and Healthy Indiana Plan (HIP) have

differences in services provided to each.

Outreach and education Assist members with PMP and/or plan selection Provide Helpline services Manage program toll-free numbers Complete quality initiatives and monitoring including monthly and

quarterly reporting Collaborate closely with OMPP and other vendors to ensure the

best possible outcomes for members and providers. Recent collaborations include the Care Select redesign and MCO procurement.

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Hoosier Healthwise

Outreach and education• Mail and outbound calling• Education about managed care programs including importance of

keeping appointments and ER utilization Health Plan and PMP selection

• 2010 – Assist with plan and PMP selection (appropriate scope of practice, choice of doctors and plans, access to information such as PMP Directories and Health Plan Summary Sheets)

• 2011 – Assist with plan selection only – health plan will link the member with a PMP

Plan Changes• Open Enrollment Periods• Just Cause

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Hoosier Healthwise, continued

Health Needs Screening• 2010 - Series of health related questions about member’s health and

environment sent to the health plans twice monthly• 2011 – Will be completed by the health Plans

Helpline services- 1.800.889.9949 Website – transitioned to www.indianamedicaid.com

• Combined provider and member website (all programs)

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Indiana Care Select

Program changes (October 1, 2010)• Transition to Care Select Disease Management program• Eligibility based on aid category and chronic condition• Voluntary – members may opt in or out

Outreach and education (Quarterly)• Mail and outbound calling• Education about the program and benefits of participating

PMP and plan selection• Appropriate scope of practice, choice of doctors and plans, access to

information such as PMP Directories and Health Plan Summary Sheets Helpline Services- 1.866.963.7383 Website – transitioned to www.indianamedicaid.com

• Combined provider and member website (all programs)

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Healthy Indiana Plan (HIP)

Helpline Services• General program information about eligibility criteria and the application

process

• Plan selection if the member has questions about the differences in the plans

• Plan changes can be made prior to the first member payment or at redetermination time

• Mail in applications sent when requested

Website - www.hip.in.gov

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Quality Assurance and Performance Monitoring

Dedicated Quality Manager

Standardized monitoring of calls and systems documentation

Data matches ensure system integrity

Required, internal & ad hoc reporting

Regular meetings with key project staff

Monthly review of performance

Corporate Quality Assurance oversight

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Questions