Thir hird T d Thur hursda sday W y Webinar binar Jan anua uary y 17 17, , 20 2019 19 Kevin Hancock/Deputy Secretary Office of Long-Term Living Department of Human Services 1
GoT GoToWEBIN oWEBINAR AR HO HOUSEKEEPING: USEKEEPING: Wha hat A t Att ttendees endees See See 2
AGEND GENDA ➢ CHC Southeast Implementation Updates • Enrollment and Plan Selection • Launch Indicators and Oversight • Launch Communications ➢ Quality Update 3
SOUTHEAST IMPLEMENTATION 4
2019 OL 2019 OLTL GO TL GOALS ALS • CHC SOUTHEAST IMPLEMENTATION-JANUARY 1, 2019: • Assuring no participant service interruptions • Assuring no interruption in provider payment • Monitor and address any issues that occur • CHC SOUTHWEST OPERATIONS AND MONITORING: • Ongoing monitoring and oversight (Operations Reports) • Focus on initiatives such as housing, employment and NHT 5
2019 OL 2019 OLTL GO TL GOALS ALS • CHC PHASE 3 IMPLEMENTATION • Comprehensive participant communication • Robust readiness review • Provider communication and training • Pre-transition and plan selection for Phase 3 participants • Incorporation of southwest and southeast implementation and launch lessons learned 6
SOUTHEAST PLAN SOUTHEAST PLAN SELEC SELECTION TION-POPU POPULA LATION TION Keystone First PA Health and Wellness UPMC (Southeast) (Southeast) (Southeast) Grand Total A: : Automatic Process 33,120 23,050 23,058 79,228 C: C: Mail il or or Fax x Ch Choic ice For orm 13,500 2,829 2,711 19,040 P: : Phon one Transaction 16,624 3,577 3,971 24,172 W: : Self elf Ser ervice e Por ortal l on on Web eb 5,928 2,727 1,648 10,303 Grand Tot otal 69,172 32,183 31,388 132,743 Per ercen ent of of Tot otal 52% 24% 24% 100% 7
SOUTHEAST PLAN SOUTHEAST PLAN SELEC SELECTION TION-POPU POPULA LATION TION A: : Automatic C: C: Mail il or or Fax x Ch Choi oice P: : Phon one W: : Self elf Ser ervice e Row La Label els Process Form Transaction Por ortal l on on Web eb Grand Tot otal NFI Du Dual 46,543 9,312 11,362 3,640 70,857 HCBS Du HC Dual 15,154 6,148 8,456 3,605 33,363 HC HCBS Non on Du Dual 8,062 2,030 4,071 995 15,158 LTC Du Dual 8,429 1,400 264 1,863 11,956 LTC Non on Du Dual 1,040 150 19 200 1,409 Grand Tot otal 79,228 19,040 24,172 10,303 132,743 Per ercen ent of of Tot otal 60% 14% 18% 8% 100% 8
SOUTHEAST SOUTHEAST PLAN PLAN SELEC SELECTION TION Keystone First PA Health and Wellness UPMC (Southeast) (Southeast) (Southeast) Grand Total NFI Du Dual 35,687 17,159 18,011 70,857 HC HCBS Du Dual 18,668 7,617 7,078 33,363 HCBS Non HC on Du Dual 10,221 2,500 2,437 15,158 LTC Du Dual 4,076 4,405 3,475 11,956 LTC Non on Du Dual 520 502 387 1,409 Grand Tot otal 69,172 32,183 31,388 132,743 9
CHC LA CHC LAUN UNCH CH INDICA INDICATOR ORS Launch Steady State (9-12 Pre-Launch (Begins at “Go Live”) Mos. & Beyond) Primary Readiness Continuity Program Improvement Aim Frequent Meetings with MCOs Regular Meetings with MCOs Readiness Reviews Key Quarterly Quality Reviews Monitor Launch Indicators & Reports System Testing Conduct Implementation Study Conduct Evaluation Analyses Activities Baseline Analyses Monitor Reports Launch Indicators Outcome Measures Readiness Review Tool Process Measures Program and Financial Reports Tools Report Templates Program Imp. Projects (PIPs) Hot-lines (Consumer & Provider) Quality Strategy Program and Financial Reports Pay for Performance (P4Ps) Consumer Communications MCO Participant Advisory Coms. Stake- Provider Communications MCO Participant Advisory Coms. Local Advisory Group Local Advisory group Ad Hoc Public Engagements holders SubMAAC, 3rd Thurs. SubMAAC, 3 rd Thurs. SubMAAC, CHC Website CHC Website CHC Website 10
LA LAUN UNCH CH INDICA INDICATOR ORS S (DOMAINS) (DOMAINS) Service Service Coordination Continuity Continuity Provider Information Participation Transfers 11
CHC CHC LA LAUN UNCH CH INDICA INDICATOR ORS 12
CHC CHC LA LAUN UNCH CH INDICA INDICATOR ORS 13
CHC CHC LA LAUN UNCH CH INDICA INDICATOR ORS 14
CHC CHC LA LAUN UNCH CH INDICA INDICATOR ORS 15
CHC CHC LA LAUN UNCH CH INDICA INDICATOR ORS 16
CHC CHC LA LAUN UNCH CH INDICA INDICATOR ORS 17
CHC CHC LA LAUN UNCH CH INDICA INDICATOR ORS 18
CHC CHC LA LAUN UNCH CH INDICA INDICATOR ORS 19
CHC CHC LA LAUN UNCH CH INDICA INDICATOR ORS 20
LA LAUN UNCH CH COMMUN COMMUNICA ICATIONS TIONS • Daily calls with individual MCOs, including weekly joint calls with all 3 MCOs. • Weekly participant and participant advocate calls. • Weekly provider association calls, including: o Nursing Facilities o HCBS Providers • Weekly calls with the Aging Network. 21
LA LAUN UNCH CH COMMUN COMMUNICA ICATIONS TIONS • Participant Help Line - 1-800-757-5042 o OLTL will staff a participant help line to address questions or concerns regarding their CHC MCO, the IEB, their service coordinator, or anything associated with the program launch. • Independent Enrollment Broker - 1-844-824-3655 OR (TTY 1-833-254- 0690) o If participants have not received their post enrollment packets, they should contact the IEB at the above telephone number or visit their website at www.enrollchc.com ( Open Monday through Friday, 8:00 a.m. to 6:00 p.m.). 22
LA LAUN UNCH CH COMMUN COMMUNICA ICATIONS TIONS • CHC-MCO Enrollment Packets: o Are mailed within 5 days of enrollment and include: • Welcome letter • ID Cards • Benefits booklet • Forms book, including health risk assessment, provider change form, etc. • BH-MCO Enrollment Packets: o Are mailed within 7-10 days of enrollment and include: • New Member Letter • Member Handbook 23
CHC QUALITY UPDATE 24
Ar Areas eas of of F Focus ocus DHS Quality Strategy (include CHC program) CHC Evaluation Plan by the Medicaid Research Center at University of Pittsburgh (7 yr.) CHC Quality Components MCO Accountability ▪ Quality Measures ▪ Performance Improvement Projects (PIPs) 25
Quality Quality Com Compone ponents nts CHC Quali lity Components CHC Quali lity Com omponents Effectiveness of Program Performance Critical Consumer Measures Incidents Surveys External Complaints Quality & Appeals Review (EQR) Network Performance Standards Improvement Projects (PIP) Monitoring Value-based & Payment Compliance (future) CHC Readiness Independent Review Evaluation Quality
CHC Evaluation Plan 27
6-Mo Mont nth h Follo ollow-Up Up Int Inter erviews (Phase I) views (Phase I) • The MRC re-contacted participants Sample Size Re-Contact Rate in the Phase I region who were 21-59 HCBS 262 53% interviewed in late 2017 60+ HCBS 286 57% Non-LTSS Duals 279 52% • Interviews conducted between: Total 827 54% • 7/30/18 to 9/14/18 • Topics to be included in a future report: • Enrollment process, plan selection, service coordination/assessment, usual source of medical care, transportation Data Source: Medicaid Research Center, University of Pittsburgh 28
Comp Compar ared ed to to bef befor ore e Jan anua uary y 1, a 1, are medica e medical l ne need eds s be being ing met met... ... Medical Care Prescription Drug Same Same Not as Not as 79% 80% Well Well 6% 5% Better Better 15% 15% Data Source: Medicaid Research Center, University of Pittsburgh 29
Performance Measures 30
31
Key ey Perf erfor ormance Measur mance Measures es • Inpatient Utilization (IPU) – General Hospital / Acute Care • Ambulatory Care (AMB) • Plan All Cause Readmissions (PCR) • Adherence to Meds for Individuals with Schizophrenia (SAA) • Schizophrenics on Antipsychotic Medication (SAA) • Access to Personal Assistance Services (PAS) • Rebalancing (Nursing Home Transition to the Community) 32
Key ey Perf erfor ormance Measur mance Measures es (KPM) (KPM) *Preliminary results are subject to change; limited use for informational purposes and as a status update for validation process. Utilization Measures AHC PHW UPMC Inpatient utilization per 1000 mm 99 47 21 ED utilization per 1000 mm 73 88 23 Readmissions % 10.7% 16.4% 17.9% Treating individuals living schizophrenia AHC PHW UPMC % on medication 83% 99% 76% % medication adherence 95% 86% 86% 33
Pennsylvania ennsylvania Perf erfor ormance Measur mance Measures es (P (PAPM) APM) • Behavioral Health Focus • Antidepressant Medication Management (AMM) • Follow-up After Hospitalization for Mental Illness (FUH) • Follow-up After Emergency Department Visit for Mental Illness (FUM) • Initiation and Engagement of Alcohol/Drug Dependence Treatment (IET) • Use of Opioids at High Dosage (UOD) • Concurrent Use of Opioids and Benzodiazapenes (COB) • Adherence to Meds for Individuals with Schizophrenia (SAA) 34
Recommend
More recommend
