Integrated Care Organization for Medicare-Medicaid Dual Eligibles NAMI – Saturday, October 20,...
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Integrated Care Organization for Medicare-Medicaid Dual Eligibles NAMI – Saturday, October 20, 2012
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Transcript of Integrated Care Organization for Medicare-Medicaid Dual Eligibles NAMI – Saturday, October 20,...
Integrated Care Organization for Medicare-Medicaid Dual Eligibles
NAMI – Saturday, October 20, 2012
page 2Blue Care Partnership of Massachusetts
About | Why are we doing this?
The current state of care for dual eligible adults has been characterized as:
Lacking coordination between Medicare and Medicaid
Fragmented and unmanaged
Not person-centered
Lacking services for care coordination and community-based alternatives
page 3Blue Care Partnership of Massachusetts
About | Blue Care Partnership
Blue Care Partnership’s goals are designed to:
Improve quality, costs, and independent living
Eliminate barriers to care
Guarantee person-centered, coordinated care
Increase access to the right services in the right locations
Simplify administrative processes
Achieve cost savings through improved coordination
page 4Blue Care Partnership of Massachusetts
About | Blue Care Partnership – Why We Came Together
Largest Massachusetts not-for-profit health plan, serves over 2M consumers
Statewide network of 21,000 primary care physicians, specialists, acute care hospitals
Medicare plans since 1966: Medicare Advantage, Medex® supplemental plans, Blue MedicareRx (Medicare Part D) prescription drug plans
Rated among the nation's best health plans for member satisfaction and quality
75 years of community partnerships
Comprehensive behavioral health services for 430,000 MassHealth Enrollees (Primary Care Clinician Plan)
Support services to Primary Care Clinicians serving MassHealth Enrollees
Parent company ValueOptions® serves 32M+ consumers. Services include: mental and emotional wellbeing, recovery and resilience, employee assistance, and wellness
Strong community involvement. Presence across MA since 1996
page 5Blue Care Partnership of Massachusetts
About | Power of the Partnership
A Member Engagement Strategy that meets members where they are and designed to place members at the center of care planning• Community-based Care Coordinators, lay Health Educators, Peer Counselors, and Community
Health Workers meeting face-to-face to members• Regular member outreach and education• “No wrong door” referral policy and process• Member-driven care plan• Culturally and linguistically appropriate
A Community Engagement Strategy that partners with community supports such as CSP providers, peer run organizations, churches, schools, universities, and local governments to provide education, training, research and outreach.
A Provider Engagement Strategy that recognizes and values providers as key members of the care plan team. • Multi-disciplinary Care Team and Care Plan• Increased Provider Flexibility
page 6Blue Care Partnership of Massachusetts
About | Power of the Partnership
Consumer & Family Council
Blue Care Partnership is committed to consumer involvement at all levels of the organization
We believe the care management, services, supports and other assistance that is provided by BCP must be provided in a manner that demonstrates respect for individual dignity, personal preferences, and cultural differences.
We believe that people with disabilities and/or lived experience have expertise that is critical to the development of our policies, programs and services as well as to the solution of problems.
BCP will create a Consumer & Family Council and hire a full time disability outreach coordinator
page 7Blue Care Partnership of Massachusetts
About | Model of Care – How does it work?
page 8Blue Care Partnership of Massachusetts
About | BCP – Additional Services
Diversionary Behavioral Health Services
Community Crisis Stabilization Community Support Program (CSP) Partial Hospitalization Acute Treatment Services for Substance Abuse Community Support Program for Substance Abuse Psychiatric Day Treatment Intensive Outpatient Program Structured Outpatient Addiction Program Program of Assertive Community Treatment Emergency Services Program
page 9Blue Care Partnership of Massachusetts
About | BCP – Additional Services
New Community-based Services(Flexible Services that may be included in the Individualized Care Plan) Day Services Home Care Services Respite Care Peer Support/Counseling/Navigation Care Transitions Assistance (across settings) Home Modifications Community Health Workers Medication Management Non-Medical Transportation
Expanded Services Preventive, Restorative, and Emergency Oral Health (Dental) Benefits Personal Care Assistance (including cueing and monitoring) Durable Medical Equipment (training in usage, repairs, modifications) Environmental Aids and Assistive/Adaptive Technology Vision Services
page 10Blue Care Partnership of Massachusetts
About | How BCP Can Help – Example
Problem: 23-year old woman diagnosed with an eating disorder and obsessive compulsive disorder symptoms
Receiving inpatient and/or acute residential treatment for very lengthy stays (averaging 50 days) eight different times over a three-year period
Her living situation contributed to her symptoms and her poor self-care, which led to medical deterioration and psychiatric crises
Solution: Care team focused on coordination among multiple medical and behavioral health providers, case conferences with facilities and practitioners caringfor her, securing consults with a dietician, and supporting her and her family with Long Term Services and supports
Result: She was successful in stabilizing her weight, engaging with a new outpatient team, moving into her own apartment, re-engaging in full-time employment, and remaining in the community
page 11Blue Care Partnership of Massachusetts
About | How BCP Can Help – Example
Problem: 56-year old man was diagnosed with lung cancer and congestive heartfailure. He lived alone and was experiencing increased anxiety and
depression. He had a friend that he relied on for transportation who was ill and no longer able to assist him with his care.
Solution: His care coordinator assisted him with securing outpatient counseling to deal with the depression and anxiety. A Community Support worker assisted with coordinating transportation and requested a social work evaluation from the VNA to assist with long-term planning and coping. Additional resources were identified to assist with further transportation needs, compliance with medication, and keeping medical appointments.
Results: After a history of multiple acute hospitalizations, he has remained in the community.
page 12Blue Care Partnership of Massachusetts
Contact
Audrey SheltoChief Executive OfficerBlue Care PartnershipBlue Cross Blue Shield of Massachusetts401 Park DriveBoston, MA 02215617-246-6114 [email protected]
Nancy Lane, PhDChief Executive OfficerMassachusetts Behavioral Health Partnership100 High Street 3rd FloorBoston, MA 02110800-495-0086 [email protected]
Thank you!
