2020 AGENDA

Chairperson

Telehealth and Our ‘New Normal’: Using Digital Platforms to Support the Care of Medicaid and Medicare Members

Telehealth has emerged as a requisite tool for supporting access to needed health care services while reducing the risk of exposure to and spread of COVID-19. Specifically, in response to the coronavirus pandemic, both the Federal government and States have issued emergency orders to increase access to and utilization of telehealth services in lieu of in-person care. According to recent data from Forrester Research, virtual health care visits could top more than 1 billion this year, including more than 900 million visits related to COVID-19. State Medicaid leaders and managed care organizations are actively considering the long-term possibilities of these new flexibilities and the long-term opportunities to integrate digital platforms long term into the Medicaid system.

• Hear about the Medicaid and Medicare telehealth landscape and the regulatory flexibilities that have been initiated due to COVID-19.
• Impact of the telehealth flexibilities in improving access to care.
• Insights into the long-term Medicaid and Medicare changes that have and could occur in telehealth given state authority

Care Coordination in the Post-Covid-19 World: Addressing Gaps in Care, Chronic Illnesses, Exacerbated Conditions & Behavioral Health

Case Management Automated Assessment Tools – Prioritizing and Providing Access to Care

The Complexity Assessment Grid (CAG) is a tool utilized to enhance Case Manager practice. It allows for clear illustration of a member's needs and opportunity for prioritization of Case Manager short-term and long-term care plan goals.  This session will highlight how to incorporate the Complexity Assessment Grid into Case Manager workflow and the benefits of automating this through electronic platforms.

Leveraging Data & Technology to Proactively Target Care Coordination Efforts and Outreach During a Pandemic

• Prioritizing Population Segments to proactively outreach at risk populations for COVID-19
• Utilize technological tools to identify and prioritize our care coordination efforts
• Introduce Care Oregon’s Regional Care Team Model and approach to care coordination
• Strategically utilize Regional Care Team Model, Network Relationships and reallocate staff for outreach efforts.

Reactive to Proactive: COVID-19 & Population Health

• Impact of COVID-19 on utilization patterns
• Implementing COVID-19 focused processes to prepare for continued surges in care demand
• Navigating the challenges of moving from a reactive population health model to a proactive model
• Identifying and addressing social determinants of health
• Harnessing the right tools and processes to proactively identify and manage the right members

Making Every Member Encounter Count: Building Care Coordination Partnerships

Navigating the pathways between the multiple silos in our healthcare system can be daunting for individuals and their family members. Difficult, fragmented, and duplicative processes between Medicaid and Medicare, between Managed Care and FFS, confound members at every turn. We will explore how fostering health plan collaborative agreements while using supportive technology to coordinate care and services in a manner that is agnostic to payer source and integrates paid services with community supports can improve the healthcare experience for our most vulnerable members while addressing cost savings with reduced service duplication and earlier identification of care gaps.

Close of Module #1

Chairperson

The Maryland Model & Care Management

The Maryland Health Care Commission (MHCC) supports advanced care delivery and quality improvement initiatives to improve health outcomes and reduce the total cost of care. This session will present a care management readiness tool under development for ambulatory practices aimed at improving patient care and reducing the need for medical services by helping patients and caregivers more effectively manage health conditions: The tool was informed by MHCCs Care Management Focus Group. The focus group consists of diverse health care stakeholders including payers, health systems, hospitals, state agencies, long term care providers, accountable care organizations, managed care organizations, consumers, and ambulatory care providers.

• Identify the need for a practice self-assessment tool to implement and optimize care management
• Summarize the key domains of readiness for care management implementation
• Describe the manner in which results and resources are presented to users

Case Study: Integrated Complex Care Management – Using Technology to Engage Patients & Boost Quality of Care

Find out how Kaiser Permanente is approaching moves to Integrated Care Management to provide better care for patients. This change moves Kaiser from care focused on specific chronic conditions such as Diabetes, Asthma or Depression to an integrated approach where the plan integrates a patient’ social needs into their care. This approach uses technology to enable care protocols and patient engagement. This presentation will discuss the process Kaiser has taken to affect the transition, review of care protocols and how they have enabled the EMR to provide care.

Data Sharing, Patient Engagement & Cross Collaborations to Coordinate Care with
Florida’s Health Information Exchange (HIE)

Today’s complex healthcare system impacts plans, providers, and patients. As health care providers work with scarcer resources, silos between health care entities can develop, thus creating obstacles to care coordination. This creates a critical need for technology and innovation. In this session Florida’s Agency for Health Care Administration representatives will provide solutions offered by the Florida Health Information Exchange designed to help overcome barriers in making the patient the focal point of care.
 Coordinate patient care through data sharing using

• Collaborate with healthcare providers, health plans, ACOs, and other organizations
• Embrace value-based model of care
• Promote patient engagement and better health facilities utilization

Moderator:

Panelists:

Home is Where the Health Is: Extended Home-Delivered Meals Programs to Support Vulnerable Members

Health plans more frequently offer long-term meals programs as part of Medicaid LTSS or HCBS waiver programs or short-term meals programs as part of Medicaid and Medicare Advantage post-discharge programs. Now is the time for mid-term or extended meals programs that can help support vulnerable populations who need support managing a chronic or acute condition like diabetes, heart disease, high risk pregnancy or behavioral health condition or who may be facing pandemic-related needs, like food insecurity or illness. Extended programs may support members for six weeks to six months and can help members to avoid hospital and SNF utilization at a time when it is critical to help members stay healthy at home. Mom’s Meals will share snapshots of a variety of innovative mid-term meals programs and the outcomes they are helping managed Medicaid and Medicare Advantage plans to achieve. Policy flexibilities that allow health plans to offer these innovative programs will also be discussed.

Including Housing Stability Assistance for Pregnant Women to Boost Birth Outcomes, Reduce Infant Mortality and Decrease NICU Use

Addressing the social determinants of health (SDoH) is essential to the provision of high quality care coordination. When a member faces housing instability, the level of services needed can be time consuming and require a significant level of expertise. Healthy Beginnings at Home in Columbus, OH demonstrates how Clinical Care coordination, Life Coach, and Housing Service Specialists working together can improve birth and housing outcomes. This session will:

• Provide an overview of Healthy Beginnings at Home including outcomes
• Discuss the integrated Care Coordination model engaging the MCO and community based organizations
• Explore the service delivery and expectations on intensity and duration

Close of Module # 2

Chairperson

Social Determinants of Health Data and Case Management Interventions: A Household Perspective

Discuss use of assessments of the Social Determinates of Health (SDoH) needs of a household to effectively assist members with these needs as well as their impact on medical care. UPMC collects SDoH information from providers, member interactions, and publicly available data sets. Information about SDoH needs is incorporated into all case management activities with the member as well as all members in their household.

• Identify effective case management interventions using SDoH data
• Discuss the use of SDoH data to make meaningful improvements to case management programs
• Identify the importance of using household information to reduce barriers to care

Organizing Community Collaboration through a Community Information Exchange Platform

Addressing social determinants of health is a community-wide effort. What is the role of managed care in the community and what inherent industry competencies can it contribute to addressing social needs? This session will present lessons learned from the ConnectIE program. ConnectIE is a two-county regional program that seeks to organize social care delivery through a common resource and referral platform that is used daily by clinicians, schools, churches, community based organizations and residents. At this session attendees will:

• Understand IEHP’s Community Information Exchange strategy,
• See ConnectIE’s utilization trends
• Become familiar with implementation challenges and promising opportunities.

Interventions to Integrate Behavioral Health and Physical Health for Members with Co-Morbid Conditions

Across the United States, behavioral health care needs are on the rise. Now more than ever, strategies, interventions, and programs designed to provide quick and easy access to behavioral health care and services are critical to improving the lives of people living with behavioral health conditions. This presentation will discuss solutions Centene has implemented to support their care coordination team in ensuring timely access and delivery of care, such as:

• Increase efficiency and effectiveness to care managers by providing an easy referral solution for members needing behavioral health care
• Support and guide care management teams with the development of a care plan for individuals with co-morbid physical and behavioral conditions

Coordinating Care for the Complex Medical and Behavioral Health Needs of Poverty and the Homeless Population

Avoidable Admissions and Readmissions – Technology and Analytics to Maximize Outcomes

• Devise a strategy on avoidable admissions utilizing technology.
• Structure analytics to determine program outcome; and ultimately, program success.
• Coordinate multiple member-centric strategies to optimize readmission prevention.

At Home Care Program: Cut Costs and Improve Outcomes

Geisinger at Home provides team-based comprehensive and acute care in the home for Geisinger Health Plan’s most complex members across Northeast and Central Pennsylvania. Geisinger’s approach combines in-person, facilitated tele-medicine, telemonitoring, outbound care coordination, and nurse triage to improve quality and manage the total cost of care.

Close of Module # 3

Chairperson

Accessing and Caring for Hard to Reach Populations

• Coordinate care for vulnerable populations, including Hispanic, those returning from incarceration, high ER utilizers, Arab, African, Veterans, seniors and the deaf and hard of hearing.
• Explore how the Flint water crisis raised awareness of the health care coverage and access challenges for populations where language and culture are barriers.
• Get the process to implement the multicultural system of care.
• Assess the usefulness and value of community engagement/community voices.
• Analyze the conversation process for identifying cultural differences.
• Hear specific outcomes from implementation.
• Investigate the impact of Covid-19 on the hard to reach populations.

Effective, Scalable Clinical Pharmacy Based Care Coordination

Learn how effective use of technology in pharmacies and call centers can drive enhanced care coordination. Appointment based medication synchronization coordinates safe and effective use of medications while creating ongoing, accountable relationships between health plan members and pharmacy staff. Custom surveys tailored to condition-specific chronic care programs can further enhance member health outcomes while improving associated health plan quality measures and reducing medical costs.

Using a Concierge Approach to Secure Medication Access for Medicare Members

Getting a needed prescription can be a challenge for many seniors on a good day and the COVID-19 pandemic made it all the more difficult in many ways. Excellus BlueCross Blue Shield used predictive analytics to identify our Medicare members at the highest risk for COVID-19. Excellus then conducted telephonic outreach to offer concierge service to convert members to 90-day supplies of medication supplies, resolve medication access issues, and offer member care management and other supportive resources.

• Use of predictive analytics to stratify risk for COVID-19 infection
• Concierge Approach vs. Traditional Methods of Outreach
• Outcomes: Measurement of Member and Employee Satisfaction, Savings for Member and Plan, Relationship between 90-day Supplies and Medication Adherence

Medication Therapy Management (MTM) 101: Effective Collaboration Strategies

Medication Therapy Management (MTM) can be of great benefit to providers and members, but the concept is often not well understood. What is MTM? How does it work? Why is it important? This session will break down the basics of MTM and the pharmaceutical care model, and discuss strategies for collaboration with other health care professionals such as care coordination.

Medication Adherence--How to Help Your Members During the COVID Outbreak

• Review the principals behind medication adherence to help members during 2020 and beyond
• How to help you member with adherence problems
• Working with the retail pharmacy and provider on adherence
• Are certain classes of medications more prone to non-adherence

Pharmacy Innovations to Ease the Impact of the Pandemic

COVID-19 has changed the world in a matter of months, and Cigna knows that as our world changes, our patients have different challenges and needs. To meet our patients where they are during these difficult times, we have created creative solutions to address issues and ensure patients get the best care possible. Areas where Cigna's Pharmacy services have innovated include:

• Partnership with SpotRx at urgent care location
• Piloting no-contact delivery service
• Appointment Based Medicine
• Providing increased access

Close of Conference