Alaska Medicaid Coordinated Care InitiativeStakeholder Report – March 16, 2015

About MedExpert

• MedExpert will provide case management and care coordination services to Alaska Medicaid members, initially focusing on “super-utilizers.”

• Since 2012, MedExpert has been assisting Medicare members.

• As one of the 107 grant awardees out of more than 3,500 applicants, MedExpert rose to being a top 5 CMS CMMI Innovation Project within the first 24 months.

• Staffed by doctors, nurses, and Medical Information Coordinators, MedExpert will work with each patient as long as it takes to solve that patient’s situation.

• MedExpert addresses all 22,000+ medical conditions, 16,000+ pharmaceuticals in use, and 154,000 primary co-morbidities. Factoring the above combinations, on any given day MedExpert can generate more than 220,000,000 different reports.

• For each patient, MedExpert answers the question: “What would the world's top experts do for my medical situation?”

MedExpert currently serves

more than 4.5 million

members in government,

labor unions, private

corporations, and school

systems.

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MedExpert’s Goal Statement

MedExpert's goal is to make the AMCCI program a positive experience for everyone. MedExpert will guide members through the health care system while working closely with the DHCS and medical community to improve the health and quality of life of Alaskans.

MedExpert will assist members to get the health care they need in the appropriate setting. Our goal is to:

• Improve health outcomes• Foster healthy independent living• Align care decisions with current evidence-based medicine• Increase adherence to preventive care• Reduce unnecessary utilization and spending

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MedExpert will provide members with the following:

• Immediate access to MedExpert doctors and nurses

• Assistance to understand medical condition

• Assistance to understand medications

• Facilitating resolution of health care problems and concerns

• Providing information about available health care resources

• Choosing the appropriate setting for health care

• Support to obtain and access the health care needed

• Assistance to make appointments

• Facilitating access to community resources for transportation, food, housing, and other assistance

• Coordinating with health care providers and community resources

• Health promotion i.e. living a healthy lifestyle

• Care transition

MedExpert will assist

members to get the health

care they need in the

appropriate setting.

MedExpert Services

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MedExpert will collaborate with:

• Physicians and other Medical Providers

• Pharmacies

• Hospitals

• Community Organizations and other Resources

• State Medicaid Office & other State Resources

MedExpert will:

• Develop cooperative relationships between the Providers, Members, and MedExpert Coordinators, Nurses, and Physicians.

• Support collaboration efforts by:

• Assisting members to appropriately use their Medicaid benefits

• Assisting members to make and keep necessary medical appointments

• Answering questions members may have before and after an appointment

• Assisting members to comply with their Medical Provider instruction

• Assisting members to comply with their plan of care

• Improving members prescription medication adherence

• Assisting members to understand informed consent prior to procedures

• Increasing understanding and compliance with discharge instructions

• Sharing best practice guidelines with Medicaid Providers, as requested

MedExpert Collaboration

MedExpert provides

support to a member’s

doctors and other

providers.

MedExpert does not treat

or diagnose.

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ParticipationAnd Utilization

Member Counts

Number Volunteer Members 507

Number Potential AMCCI Members 1,755

Total Members Eligible for AMCCI Program* 2,263The following table identifies

total activity in the following

date range:

12/26/14 – 3/16/15 Members Contacted

# Members Contacted – Successfully 788

# Members Contacted – Left Message 613

# Members Contacted – Do Not Call List 15

# Members Contacted – No Answer, Unable to Leave Message 474

# Members Contacted – Disconnected 434

# Members Contacted – Wrong Number 158

# Total Members Attempted 2,324

*Initial members assigned

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ParticipationAnd Utilization

The following table

identifies total activity in the

following date range:

12/26/14 – 3/16/15

Member Engagement

Unique AMCCI Members with a Medical Discussion 677

Unique AMCCI Members with Episodes* 115

Total Number of Episodes* 574

Average Number of Episodes Per Member 4.99

*An episode is a series of discussions relating to one or multiple medical subjects lasting until a resolution or Plan of Care is determined.

Contact By Percentage

Percent of Members with Medical Discussion 29.1%

Percent of Members Episodes 4.95%

Percent of Successfully Contacted Members with Episodes 14.6%

Episode* Subjects

Number of Unique Medical Subjects Discussed 342

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Unique Medical Subjects Discussed

Topics 1 through 100

1 Ablation Techniques 26 Arthritis, Rheumatoid 51 Cellulitis 76 Diarrhea

2 Accidental Falls 27 Arthroplasty, Replacement, Hip 52Child Development Disorders,

Pervasive77 Diet, Carbohydrate-Restricted

3 Acetaminophen 28 Arthroplasty, Replacement, Knee 53 Child Psychology 78 Diet, Gluten-Free

4 Acetazolamide 29 Aspirin 54Cholangiopancreatography,

Endoscopic Retrograde79 Diet, Mediterranean

5Acquired Immunodeficiency

Syndrome30 Asthma 55 Cholecystectomy 80 Dietary Supplements

6 Adult Survivors of Child Abuse 31 Atrial Fibrillation 56 Cholecystectomy, Laparoscopic 81 Discogenic Back Pain

7 Alcohol Withdrawal Delirium 32Attention Deficit Disorder with

Hyperactivity57 Cholelithiasis 82 Domestic Violence

8 Alcohol Withdrawal Seizures 33 Autistic Disorder 58 Cholesterol 83 Dysmenorrhea

9 Alcoholic Neuropathy 34 Autoimmune Diseases 59 Chronic Pain 84 Dyspnea

10 Alcoholism 35 Back Pain 60 Citalopram 85 Eczema

11 Alendronate 36 Barrett Esophagus 61 Clonazepam 86 Edema

12 Amenorrhea 37 Bereavement 62 Constipation 87 Emphysema

13 Anemia 38 Bipolar Disorder 63Continuous Positive Airway

Pressure88 Endometriosis

14 Angioplasty 39 Blood Transfusion 64 Contraception 89 Epilepsy

15 Anti-Anxiety Agents 40 Bone Density 65 Contracture 90 Exercise

16 Anti-Bacterial Agents 41 Brain Concussion 66 Cough 91 Fatigue

17 Anti-Inflammatory Agents 42 Bulimia 67 Delusions 92 Fatty Liver

18 Anticonvulsants 43 Calcium 68 Depression 93 Fever

19 Antidepressive Agents 44 Carbohydrates 69 Diabetes Mellitus 94 Fibromyalgia

20 Antipsychotic Agents 45 Cardiomyopathy, Dilated 70 Diabetes Mellitus, Type 2 95 Fibrosis

21 Anxiety 46 Caregivers 71 Diabetes, Gestational 96 Flatulence

22 Anxiety Disorders 47 Carotid Artery Diseases 72 Diabetic Diet 97 Food Habits

23 Aphasia 48 Cataplexy 73 Diabetic Neuropathies 98 Food Hypersensitivity

24 Arthritis 49 Catheter Ablation 74 Diabetic Retinopathy 99 Fractures

25 Arthritis, Infectious 50 Celiac Disease 75 Dialysis 100 Framycetin

300 total unique

medical subjects

discussed with Alaskan

AMCCI members.

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Unique Medical Subjects Discussed

101 Fungi 126 Hydrochlorothiazide 151 Kidney Failure 176 Migraine Disorders

102 Gait Ataxia 127 Hypercalcemia 152 Knee Injuries 177 Mobility Limitation

103 Gastric Bypass 128 Hypercholesterolemia 153 Korsakoff Syndrome 178 Multiple Sclerosis

104 Gastroesophageal Reflux 129 Hyperlipidemias 154 Lactose Intolerance 179 Mumps

105 Gastroparesis 130 Hypersensitivity 155 Laser Therapy, Low-Level 180 Muscle Cramp

106 Ginger 131 Hypertension 156 Leiomyoma 181Muscle Stretching

Exercises

107 Growth and Development 132 Hypertension, Portal 157 Ligaments 182 Muscle Weakness

108 Headache 133 Hypesthesia 158 Lorazepam 183 Myocardial Infarction

109Health Insurance Portability and

Accountability Act134 Hypoglycemia 159 Low Back Pain 184 Narcolepsy

110 Health Personnel 135 Hypotension 160 Lupus Nephritis 185 Narcotics

111 Health Services Accessibility 136 Hypotension, Orthostatic 161 Lupus Vulgaris 186 Neck Pain

112 Hearing Disorders 137 Hysterectomy 162 Magnesium 187 Neoplasms

113 Hearing Loss 138 Ibuprofen 163 Massage 188 Nerve Block

114 Heart Diseases 139 Influenza, Human 164 Mastocytosis, Systemic 189 Neurodermatitis

115 Heart Murmurs 140 Injections, Intra-Articular 165 Medicaid 190 Neuromuscular Agents

116 Heart Septal Defects, Atrial 141 Insurance Coverage 166 Melatonin 191 Nutrition Assessment

117 Helicobacter pylori 142 Insurance, Disability 167 Meniere Disease 192Nutritional Physiological

Phenomena

118 Hematoma, Subdural 143 Insurance, Pharmaceutical Services 168 Menisci, Tibial, Tear 193 Obesity

119 Hemoglobin C 144 Intellectual Disability 169 Mental Health 194 Obesity, Morbid

120 Hemophilia A 145 Intermittent Claudication 170 Mentha piperita 195Obstetric Labor,

Premature

121 Hepatitis C 146 Intertrigo 171 Metabolic Detoxication, Drug 196 Omeprazole

122 Herpes Zoster 147 Intervertebral Disc Displacement 172 Methadone 197 Opioid-Related Disorders

123 Hip Dislocation, Congenital 148 Intracranial Hypertension 173 Methamphetamine 198 Osteoarthritis, Hip

124 Hip Joint 149 Irritable Bowel Syndrome 174 Methicillin resistant staphylococcus aureus 199 Osteoarthritis, Knee

125 Histamine H1 Antagonists 150 Ischemic Attack, Transient 175 Methotrexate 200 Osteoarthritis, Spinal

300 total unique

medical subjects

discussed with Alaskan

AMCCI members.

Topics 101 through 200

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Unique Medical Subjects Discussed

201 Osteoarthritis, Spine 226 Prednisone 251 Sleep Apnea Syndromes 276 Thiamine Deficiency

202 Osteomyelitis 227 Pregnancy 252 Sleep Disorders 277 Thoracic Surgery

203 Overweight 228 Pregnancy, Ectopic 253Sleep Initiation and Maintenance

Disorders278 Thrombocytopenia

204 Oxycodone 229 Psychoanalytic Therapy 254 Smoking Cessation 279 Thrombosis

205 Pain 230Pulmonary Disease, Chronic

Obstructive255 Social Isolation 280 Tinnitus

206 Pain Management 231 Pulsed Radiofrequency Treatment 256 Somatoform Disorders 281 Tobacco Use Cessation

207 Pain Measurement 232 Pyroglyphidae 257 Spasm 282 Tooth Eruption

208 Pancreatitis 233 Radiculopathy 258 Spinal Fusion 283 Tooth Injuries

209 Pancreatitis, Chronic 234 Raynaud Disease 259 Spinal Stenosis 284 Transportation

210 Paresthesia 235 Reflex Sympathetic Dystrophy 260 Splenomegaly 285 Transportation of Patients

211 Parkinson Disease 236 Rehabilitation Centers 261 Stents 286 Trigeminal Neuralgia

212 Paroxetine 237 Relaxation Therapy 262 Stomach Diseases 287 Ubiquinone

213 Peptic Ulcer 238 Rhinitis, Allergic, Seasonal 263 Stress Disorders, Post-Traumatic 288 Urinary Tract Infections

214 Peptic Ulcer Perforation 239 Rhizotomy 264 Stress, Physiological 289Uveomeningoencephalitic

Syndrome

215Peripheral Nervous System

Diseases240 Riboflavin 265 Stroke 290 Vagus Nerve Stimulation

216 Pharmaceutical Services 241 Rotator Cuff 266 Substance Abuse Treatment Centers 291 Valproic Acid

217 Pharyngitis 242 Sciatica 267 Substance Withdrawal Syndrome 292 Vision Disorders

218 Physical Therapy Specialty 243 Scleroderma, Systemic 268 Substance-Related Disorders 293 Vision Disparity

219 Pilonidal Sinus 244 Scoliosis 269 Sucralfate 294 Vitamin D

220 Placenta Previa 245 Senna Plant 270 Suicidal Ideation 295 Vitamin D Deficiency

221 Pneumococcal Vaccines 246 Sensation Disorders 271 Suicide, Attempted 296 Vomiting

222 Polydipsia, Psychogenic 247 Sertraline 272 Syncope 297 Warfarin

223 Post-Concussion Syndrome 248 Shoulder Pain 273 Syringomyelia 298 Water-Electrolyte Balance

224 Postural Balance 249 Sinusitis 274 Tendinitis 299 Weight Loss

225 Prediabetic State 250 Sjogren's Syndrome 275 Testosterone 300 Whipple Disease

300 total unique

medical subjects

discussed with Alaskan

AMCCI members.

Topics 201 through 300

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CMS Results MedExpert Award Statistics

• Greater than 340,000 individuals have been reached by MedExpert during the CMS Innovation Award

• 20,709 Episodes

• 4,281 Unique Medical Subjects

• All 50 states represented in assisted population

A CMS third party independent evaluator reported the following trends starting in Q3 of the Innovation Award

• Reduction in ER Utilization

• Decrease in Admissions

• Decrease in Readmissions

• Decrease in 30,60, 90 day re-hospitalization

• MedExpert was found to have a “contagious factor” due to the increasing number of unregistered participants calling the MedExpert office for assistance

MedExpert looks forward to working with Alaskans.

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Case Story

63-Year-Old Female

Fairbanks, Alaska

Case commenced:

2 days ago

Member History• Unmanageable seizures• Rheumatoid arthritis• Temporary full-body paralysis• Multiple surgeries to restore limb function

MedExpert Episodes• Seizures• Vagus Nerve Stimulation

MedExpert Intervention and Case Strategy

• Member is scheduled for surgery to implant an ultrasonic device to alleviate/control seizures

• MedExpert spent unlimited time with patient to ensure she understood all components of the procedure

• MedExpert coordinated transportation

• MedExpert reviewed Post-surgery EBM based plan with member

• Member’s seizures may have been a cause of serious injuries over the course of her life

• Surgery may reduce medical expenses and preventable injury expenses

The member has indicated she will continue her relationship with MedExpert and she is appreciative “to have a shoulder to lean on.”

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Case Story

63-Year-Old Female

Fairbanks, Alaska

Case commenced:

2 days ago

A MedExpert International (MI) Medical Information Coordinator (MIC) conducted a routine outreach call to a 63-year-old female living in Alaska to introduce herself as this member’s case manager in the AMCCI program.

The member was receptive when the first call was placed and proceeded to cry when she understood that someone was there to assist her and support her through her medical difficulties.

The member has experienced unmanageable seizures throughout the course of her life; was diagnosed with rheumatoid arthritis and spent a period of time paralyzed from the neck down until multiple surgeries were able to restore function to her limbs.

In two weeks, the member is scheduled for brain surgery to implant an ultrasonic device to alleviate her seizures. Upon speaking with a MedExpert physician, he noted that her seizures have been causing serious injuries and over the course of her life having this surgery may reduce her medical expenses and preventable injuries.

Her MI case manager noted the member was frightened. Patient reports that member’ treating doctor scheduled the surgery but had not been able to explain the procedure or alleviate her fears purportedly due to his busy schedule.

Member’s MedExpert team has placed calls to her existing medical team to ensure her transportation and surgery will be coordinated to maximize the chance of success. MI is ensuring this member experiences true informed consent; is removing the burden from the patient; encouraging the patient to sleep and take good care of herself and MI is coordinating her next steps. The member’s goal is to be able to walk outside again and return to her normal daily life after recovering from surgery.

After surgery and when the member is ready to take on the next medical problem, her MedExpert team plans to address her medical difficulties and determine the most appropriate evidence based plan. Her rheumatoid arthritis, possible drug addiction, and other family related issues challenge her every day and have already been discussed during several discussions with her MedExpert team.

The member has indicated she will continue her relationship with MedExpert and she is appreciative “to have a shoulder to lean on.” 13

Member History• Trigeminal neuralgia• Brain stem mass• Eye arteriovenous malformation• Sciatica• Oxycodone Rx• Heart attack; two stents

MedExpert Episodes• Trigeminal neuralgia• Angioplasty• Intervertebral Disc Displacement

MedExpert Intervention and Case Strategy

• Member called MedExpert due to undiagnosed testicular pain and proceeded to discuss additional unresolved issues.

• Member’s doctor believes his pain stems from his nerves; member has blood in his urine, (stones RO).

• MedExpert’s goal is to assist the gentleman, maintain his trust, and help him determine what is causing the unbearable testicular pain.

• MedExpert will spend unlimited time with member to educate him using evidence-based information about his health; teach him what question he should get answered; and explain any questions he may have.

Case Story

57-Year-Old Male

Anchorage, Alaska

Case commenced:

6 days ago

“I am the reason they have pain clinics.”

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A 57-year-old male was leaving for vacation within days and was having horrible pain in his testicles that started when he got in a car accident with a moose. When the MedExpert Medical Information Coordinator called to introduce himself as this gentleman’s case manager, he was interested in discussing his testicular pain.

The member conveyed that he had been to a urologist, tried antibiotics, and received a CT scan and angiogram earlier that day but nothing helped or identified the cause of the problem. This member had a history of trigeminal neuralgia, a brain stem mass, eye arteriovenous malformation, and sciatica. For his pain, he is currently taking Oxycodone. He also indicated that he had an appointment with his doctor the following day and would follow up with his case manager after the appointment.

The member called his MI case manager the following day immediately after his appointment and asked to speak with a MedExpert Medical Director (MD). Although he indicated he was being cared for by a group of doctors he liked, he had questions about his testicles. The member told his case physician that he had a heart attack a bit over a year ago and when it happened it flared a nerve in his face and he was in terrible pain. He claims “I am the reason they have pain clinics.” After the heart attack he had two stents put in.

At this point, the member’s doctors think his testicular pain stems from his nerves. He has blood in his urine but they cannot find stones.

The MedExpert team is working with this member by taking the time to fully explain what his doctors are telling him, answering questions and anticipating questions that need to be addressed following the tests. The member may send MI the results of his tests help explain what the results mean. MedExpert’s goal is to assist the gentleman, maintain his trust, and help him determine what is causing the unbearable testicular pain.

This member is in the early stages of case management and will continue to be followed. He will be provided with evidence based medicine for him and his physicians as the case progresses.

Case Story

57-Year-Old Male

Anchorage, Alaska

Case commenced:

6 days ago

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Member History• Spinal stenosis• Scoliosis• Chronic back pain • Removed right ovary and right tube• Carpal tunnel in left hand• Spinal bone spur

MedExpert Episodes• Scoliosis• Chronic Pain• Percocet / Oxycodone• Spinal Stenosis• Discogenic Back Pain• Anti-inflammatory Agents

MedExpert Intervention and Case Strategy

• Member is concerned with identifying assistance to pay for pain medications.

• Member divulged to her case physician she is taking: Paxil, Ambien, Xanax, Topical Voltaren, Gabapetin, Meloxicam, Methocarbamol, and Percocet.

• The MID ran a FAME report on Chronic Pain; report concluded, based on the results of a definitive expert, hypnotic and psychological approaches and treatments for chronic pain management.

• The strategy with this patient is to maintain her trust and identify what the best in the world are doing that could improve the quality of her life and slowly make an effort to help her make better lifestyle decisions.

Case Story

34-Year-Old Female

Anchorage, Alaska

Case commenced:

7 days ago

The strategy with this patient is to maintain her trust and identify what the best in the world are doing that could improve the quality of her life and slowly make an effort to help her make better lifestyle decisions.

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A 34-year-old female returned her case manager’s call after receiving a voicemail introducing the AMCCI program. After numerous discussions, her biggest concern is identifying assistance to pay for her medication.

The member has had spinal stenosis, scoliosis, and back pain since she was 15 years old. She managed the pain through her first three pregnancies but her fourth pregnancy escalated the pain to a severe and unbearable level. She has disk surgery scheduled for the end of February and fell yesterday causing her even more pain.

She has tried physical therapy, medication, nerve blocks, and epidurals for the pain and nothing has seemed to work. The member does not feel like her pain management specialist acknowledges her pain and she is taking Percocet 10/325 at a dose of 5 per day and it does nothing at all.

After a few conversations with her case manager, she decided that she would like to speak with a MedExpert Medical Information Director (MID). The member divulged to her case physician that she was also taking Paxil, Ambien, Xanax, Topical Voltaren, Gabapetin, Meloxicam, and Methocarbamol in addition to the Percocet for other issues such as anxiety, nerve pain, and other medical problems; she is allergic to Vicodin, Tramadol, and Tyco #3. The member has also had an emergency removal of her right ovary and right tube, carpal tunnel in her left hand, a bone spur in her spine, and several other surgeries.

To maintain the patient’s trust, the case physician prioritized the issues at hand and gently started to discuss potential problems with taking certain medications together looking for presenting side effects. Chronic pain is currently her main focus and the MID requested to run an FAME report on Chronic Pain. The report concluded that one of the definitive experts in the world practices in Seattle, Washington and a knowledge transfer is appropriate for treatment in Alaska based on expert’s knowledge. This member’s MedExpert team contacted this expert on behalf of the patient to extend the knowledge to the member’s current place of care.

The strategy with this patient is to maintain her trust and identify what the best in the world are doing that could improve the quality of her life and slowly make an effort to help her make better lifestyle decisions. This information will be relayed back to her current doctors in an effort to coordinate her care.

Case Story

34-Year-Old Female

Anchorage, Alaska

Case commenced:

7 days ago

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