All Blue 2014 Workshop

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The Effects of ACA on Cover Tennessee

CoverTN – Ended Dec. 31, 20131. Provider service line remains open (1-800-924-7141)

2. Timely filing deadline for claims has expired3. Corrected bills timely filing deadline – within two

(2) years of the end of the year the original claim was filed

AccessTN – Membership significantly reduced

CoverKids continues to grow

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Our Members are Throughout the State

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Significant Changes in CoverKids

TennCareSelect Network1. Effective Oct. 1, 20132. Refer to BlueCare Tennessee Provider

Administration Manual3. Need Medicaid provider number and Ownership

and Disclosure (OWDC) on file4. Member benefits remain the same

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Significant changes in CoverKids (cont’d)

5. Quest Diagnostics became the exclusive lab provider for CoverKids and

HealthyTN Babies members under the TennCareSelect network.• Effective Oct. 1, 2013• For routine outpatient laboratory services• In both urban and rural areas across the state

with the exception of those covered services described on the Exclusion List

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HealthyTNBabies (HTNB)

New ID Card for each pregnancyOnly routine nursery care covered under mother’s ID Baby will need his or her own policy for any other care:• Effective July 15, 2014, newborns are eligible

for CoverKids for one year beginning with the date the mother enrolled in HTNB.

• No new application required.- Encourage mother to contact Maximus with

baby’s information (1-866-620-8864) - Must apply within 30 days of birth - Baby will receive her or his own ID card

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CoverKids Member ID Cards

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What is HEDIS®? Why is HEDIS important?Healthcare Effectiveness Data & Information Set

The most widely used set of standardized performance measures in the managed care industry

A tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service

A nationally recognized indicator of quality in the health care industry

Good HEDIS scores indicate Quality outcomes for our members!

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HEDIS Priority MeasuresChildren’s and Adolescent’s Access to Primary Care Provider (12 months to 19 years)Well Child Visits Childhood and Adolescent’s Immunizations – prior to their second and 13th birthday’sAdolescent Well Care visits (2-21 years)Weight Assessment and Counseling for Nutrition and Physical activity (3-17 years)Use of Appropriate Medication for People with Asthma (5-18 years)Follow up Care for Children Prescribed ADHD Medication (6-12 years)Chlamydia Screening (16-24 years)Comprehensive Diabetes Care (0-18 years)

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HEDIS Quality OutcomesMeasure HEDIS 2013

for MY 2012HEDIS 2014for MY 2013

**Benchmark

Well-Child Visits in the First 15 Months of Life: 6 or More Visits Total

74.47%

79.13% 77.44%

Immunizations for Adolescents Combo 1 Meningococcal Tdap/Td

54.99%56.20%83.94%

62.84%62.84%88.26%

85.64%89.06%93.19%

Chlamydia Screening in Women Age modified HEDIS 16-18 years 16-20 years Total 16-24 years

31.8%31.14%31.23%

31.9%

31.99%32.49%

66.38%(16-20Yrs)

66.81%

Use of Appropriate Medications for People with Asthma 5-11 years 12-18 years

95.60%87.83%

95.67%91.36%

94.92%(5-11Yrs)92.16%

(12-18Yrs)

Diabetes Care: HbA1c Testing 0-18 Years (age modified HEDIS specifications)

86.3%

92.7% 91.11%

(18-75 Yrs)

Follow-up Care for Children Prescribed ADHD Medication Initiation Continuation & Maintenance

40.71%50.65%

44.73%56.77%

51.86%63.75%

HealthyTNBabies: Prenatal and Postpartum Care Prenatal Care Postpartum Care

71.05%60.10%

73.62%64.07%

92.82%73.83%

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Quality Improvement ActivitiesProvider outreach and education (face-to-face, telephonic, mailed and through website)Appointment scheduling for membersMember outreach and education (face-to-face, telephonic, mailed, email text messaging, through website and Facebook)Member, provider and staff educational communications (articles, brochures, monitors, posters)Community outreach events (face-to-face education, screenings)

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What can you do to improve health care quality?

Educate members at every opportunitySchedule appointments and send remindersClose gaps in care by providing age and gender recommended preventive and chronic care screenings at every appointmentRefer our members to Care Management programs

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kidcentraltn.com

Tennessee’s one-stop-shop for families to raise healthy and happy kids of all ages

Questions? Visit our Cover Tennessee Resource Center

BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association