Transcript Document

Integrated Care Organization
for Medicare-Medicaid Dual Eligibles
NAMI – Saturday, October 20, 2012
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
Blue Care Partnership of Massachusetts
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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
Blue Care Partnership of Massachusetts
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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
Blue Care Partnership of Massachusetts
 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
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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
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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
Blue Care Partnership of Massachusetts
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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
Blue Care Partnership of Massachusetts
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About | Model of Care – How does it work?
Blue Care Partnership of Massachusetts
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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
Blue Care Partnership of Massachusetts
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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
Blue Care Partnership of Massachusetts
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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 caring
for 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
Blue Care Partnership of Massachusetts
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About | How BCP Can Help – Example
Problem: 56-year old man was diagnosed with lung cancer and congestive heart
failure. 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.
Blue Care Partnership of Massachusetts
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Contact
Thank you!
Audrey Shelto
Chief Executive Officer
Blue Care Partnership
Blue Cross Blue Shield of Massachusetts
401 Park Drive
Boston, MA 02215
617-246-6114
[email protected]
Blue Care Partnership of Massachusetts
Nancy Lane, PhD
Chief Executive Officer
Massachusetts Behavioral Health Partnership
100 High Street 3rd Floor
Boston, MA 02110
800-495-0086
[email protected]
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