Transcript Healthy Behaviors Program

Iowa Health and Wellness Plan
Maddisen Kies,
Communications Analyst
Iowa Medicaid Enterprise
One Plan, Two Options
Iowa Wellness Plan
• For adults age 19 - 64
• Income up to and including 100% of the Federal
Poverty Level
Marketplace Choice Plan
• For adults age 19 - 64
• Income 101% to no more than 133% of the Federal
Poverty Level
2
Iowa Wellness Plan: 0-100% FPL
Quick Facts
•
Administered by Iowa Medicaid
•
Uses Iowa Medicaid provider network
•
Offers comprehensive set of benefits
•
Uses a primary care case management (PCCM)
program, referred to as managed care
•
Primary Care Patient Manager, or primary care provider
(PCP) coordinates care and referrals for the member
3
Iowa Wellness Plan: 0-100% FPL
Member Enrollment
•
Iowa Wellness Plan members have 1,500 primary care
providers available, in addition to other contracted
Medicaid providers
•
All members have access to local providers (doctors,
hospitals, pharmacies, etc.)
•
In 87 counties, members will be assigned to a primary
care physician of their choice in their county (where
approx. 94% of members live)
4
Iowa Wellness Plan: 0-100% FPL
Provider Incentives: Physician is contracted
similar to MediPASS (current managed care
program)
•
Primary Care Physician (PCP) is eligible to earn four
additional types of payments above the regular fee-forservice payment
Primary Care Case
Manager Monthly
Payment
Wellness Exam
Incentive
Wellness Plan
Medical Home
Value Index Score
Bonus
HRA Incentive for
Incorporation Into
Care Plan
$4 Per Member Per
Month (PMPM)
$10 Per Member
Annually
Up to $4 Per
Member Per Month
(PMPM)
$25 Per Member
Annually
5
Marketplace Choice Plan: 101-133% FPL
Quick Facts
•
Members select a certain commercial health plan
available on the Health Insurance Marketplace
•
Medicaid pays the premiums to the commercial health
plan on behalf of the member
•
Offers comprehensive set of benefits
•
Commercial health plans available to members are
CoOportunity Health and Coventry Health Care of Iowa
•
Uses the commercial plan’s statewide provider network
6
Medically Exempt
• Members who are considered ‘Medically Exempt’
must be given the option of enrolling in regular
State Medicaid Plan or Wellness Plan
‘Medically Exempt’ includes individuals with disabling mental disorders (including adults with
serious mental illness), individuals with chronic substance use disorders, individuals with serious
and complex medical conditions, individuals with a physical, intellectual or developmental
disability that significantly impairs their ability to perform 1 or more activities of daily living, or
individuals with a disability determination based on Social Security criteria
• Medicaid has a process to screen for Medically
Exempt members, both at enrollment, after
enrollment, and through provider referral
7
Healthy Behaviors Program
Healthy Behaviors Program Brand
New branding exclusively for the Iowa
Health and Wellness Plan
Healthy Behaviors Program Goals
Members take active role in their
health care
Engage providers and develop plan
of care with primary care provider
Meet federal requirement (CMS) for
program
10
Healthy Behaviors Program
• Members take active
role in their health
care
• Helps waive any
possible contribution
(premium) for the next
year of enrollment
Physical
Exam
No
Premium
in 2015
Health Risk
Assessment
Healthy Behaviors Program
• Members have 12 months to complete Healthy
Behaviors
o Enrolled in January 2014, have until January 2015
o Enrolled in April 2014, have until April 2015
• Contribution amount if activities not completed:
o Wellness Plan (50-100% FPL): $5 per month
o Marketplace Choice Plan (101-133% FPL): $10 per
month
Wellness Exam
•
Identify the member’s primary care provider
o
o
•
Make sure member keeps appointment
Any wellness exam since the beginning of their eligibility
qualifies, if billed correctly
If unknown, member can:
o
o
Call Iowa Medicaid Member Services at
1-800-338-8366 (8-5, M-F)
Member Services can share provider and phone #
13
Health Risk Assessment
Wellness Plan Members
1. Using tool called Assess My Health
•
AssessMyHealth.com
2. Can be completed online or by phone
•
By phone through IME Member Services
3. Member gets 5-digit code from their provider,
enters code on assessment
Assess My Health
•
•
•
•
8th grade reading level
Available in English or Spanish
Takes 15-40 minutes
Asks questions about health
o Additional questions based on health
conditions
Assess My Health
Assess My Health
Health Risk Assessment
Marketplace Choice Plan Members
• CoOportunity Health members should use their
assessment: www.cooportunityhealth.com
• Coventry members should use their
assessment: www.coventryhealthcare.com
• Can also use Assess My Health if the member
prefers
Healthy Behaviors Outreach Campaign Strategy
Community Based Organizations as
Intermediaries
Health and Wellness Plan
Members
CAC’s &
Navigators
Comm.
Action
Agencies
Community Social
Service Agencies
Food
Banks /
Homeless
Shelters
Agencies Serving
Low Income Adults
United Way
Counties / Local
Health
Organizations
Faith-Based
Organizations
IME Provides Training and
Materials
Accountable Care Organizations &
Medical Homes
Public
Health
Depts /
WIC
Churches
19
Member Campaign
• All members received a letter and flyer end of
May
• Ongoing communications beginning in
September, continuing throughout the year
• Active community outreach, events, educational
forums
Outreach Support
• Provider Toolkit Available:
http://dhs.iowa.gov/sites/default/files/Provider%2
0Healthy%20Behaviors%20Toolkit_05092014_0
.pdf
• Stakeholder toolkit and other resources coming
• Event ideas, support or collaboration
opportunities, contact: [email protected]
Application Process
Federal Health
Insurance
Marketplace
www.HealthCare.gov
DHS website
dhsservices.iowa.gov
DHS Contact Center
1-855-889-7985
DHS Local Offices
APPLICATION
PROCESS
22
Information
Find up-to-date information on
the Iowa Health and Wellness Plan at:
http://dhs.iowa.gov/ime/about/iowa-health-andwellness-plan
Member Site:
www.iahealthlink.gov
23