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Alabama Community Care Provider Presentation

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Alabama Community Care
Provider Presentation
Region A in North Alabama
December 2014
www.alabamacommunitycare.org
Today’s Agenda
I. Introduction to Alabama Community Care –
II.
III.
IV.
V.
Alabama Plan to Transform Medicaid
Regional Care Organizations– A Plan to
Transform Medicaid
Alabama Community Care – A Different
Approach to Medicaid RCOs
Alabama Community Care – Taking the Best
from Each Organization
Alabama Community Care – Align with AMA
and Triple Aim Goals
www.alabamacommunitycare.org
2
Introduction to Alabama
Community Care
An Integrated Approach for
North Alabama
3
www.alabamacommunitycare.org
A Community Led
Managed Medicaid Model
• Partners Include:
– Huntsville Hospital Health
System
NACC
Best Start Program
NAMCI
Sentara Healthcare
–
–
–
–
• Local Office & Care
Management Staff
• Same Quality Focus
www.alabamacommunitycare.org
4
Regional Care
Organizations
Alabama Plan to
Transform Medicaid
5
www.alabamacommunitycare.org
Regional Care Organizations
• Community and provider led
• Not-for-profit
• Bear all of the underwriting risk
6
www.alabamacommunitycare.org
Alabama Medicaid
Agency (AMA) Goals
• Transform care
delivery
• Expand access
• Improve outcomes
• Address provider
reimbursement
7
www.alabamacommunitycare.org
AMA Reform Approach
Governor
Advisory
Commission
Medicaid Reform Proposal
• Delivery System Reform
• Medicaid Financing
• Payment Reform
Legislation
Amended
Feb – May 2013
www.alabamacommunitycare.org
1. 1115 Waiver
Submission
May 30, 2014
2. Regulatory
Action
3. Implementation
October 2016
8
Alabama Community Care
A Different Approach to
Medicaid RCOs
9
www.alabamacommunitycare.org
Alabama Community Care
Managing Cost and Quality
Assume:
• 90-92% of every premium
•
•
dollar goes toward
medical care
Focus on quality and
efficiency (ex: ED use,
admissions) outcomes
Providers must be part of
care delivery solution
10
www.alabamacommunitycare.org
Make a Difference for
Providers
• Eliminate unnecessary
•
•
•
•
work
Educate members about
benefits & appropriate use
of services
Enhance patient alignment
with health homes
Improve cash flow
Introduce quality and
efficiency incentives
11
www.alabamacommunitycare.org
Provide Perspective about the
New Medicaid Environment
• Health Care Industry
is Changing
• Legislature and
Governor Support
Managed Medicaid
• Opportunity to be
Part of the Solution
12
www.alabamacommunitycare.org
Alabama Community Care
Taking the Best from Each Organization
13
www.alabamacommunitycare.org
Shared History & Culture
1895
1888
The Infirmary is opened in
Huntsville, AL
A 25 bed Retreat for the Sick is
opened in Norfolk, VA
" Our mission is to provide quality
care that improves the health of
those we serve”
“Our mission is to improve health
everyday”
14
www.alabamacommunitycare.org
Sentara Health Plans
• 30 year history
• 450,000 members
• Employer-sponsored
group plans
• Marketplace Plans
• Medicare Advantage
Plans
• Medicaid Plans
15
www.alabamacommunitycare.org
Sentara Medicaid
• 19 year Medicaid History
• 171,000 Members
• Claims Processing
Performance Measures
• Excellent Provider and
Customer Service
16
www.alabamacommunitycare.org
Focus on Member High Touch
• Improve Health
‒ Outreach to new members
‒ Submit assessments electronically
‒ Wellness reminder calls
• Clinical Outreach:
‒ Outreach to hard to find members
‒ Contact ER frequent users
• Community Partnerships:
‒ Participate in local community
health fairs
‒ Work with local agencies
www.alabamacommunitycare.org
17
Alabama Community Care
Align with AMA and
Triple Aim Goals
18
www.alabamacommunitycare.org
Alignment with AMA
and Triple Aim
I. Transform care delivery
• Primary Care Medical Homes
• Ensure ease of access to PMPs
• Reduce administrative burden
on PMPs
19
www.alabamacommunitycare.org
Alignment with AMA
and Triple Aim
II. Support Member Access
• Evaluate efficacy of visit limits
• Assess and reward open practices
• Reward member panel size
• Consider inclusion of a non-emergent
transportation benefit
Note: Final decisions dependent on adequacy of RCO capitation rates
www.alabamacommunitycare.org
20
Alignment with AMA
and Triple Aim
III. Improve Outcomes
•
•
•
•
•
•
Physician led teams
Population-based data analysis
Determine baseline metrics
Set evidence-based goals
Develop programs to incentivize change
Measure and report results
Note: Final decisions dependent on adequacy of RCO capitation rates
www.alabamacommunitycare.org
21
Alignment with AMA
and Triple Aim
IV. Address Provider Reimbursement
• Physician rates
– AMA information late December
– Updates from AMA will be posted to our
website
• Final rates will be sent as an amendment
to the provider contract
Note: Final decisions dependent on adequacy of RCO capitation rates
www.alabamacommunitycare.org
22
Provider Credentialing
Simplified Credentialing Process:
• Delegating function to NAMCI
• Will follow NAMCI and national
standards
– NCQA
• No additional requirements
www.alabamacommunitycare.org
Provider Connection
Secure Online Tools:
• Pre-Authorization Forms
• Quarterly Pharmacy Updates
• Pharmacy Utilization Management
Information
• Alabama Community Care Provider Manual
• Health Care Reform Updates
• Participating Providers Search
www.alabamacommunitycare.org
What to Expect
1. We’ll keep you informed
www.alabamacommunitycare.org
2. Send you a LOI/agreement in
January
3. 3/1/15 contract submission
deadline
4. Full orientation before effective
date and implementation
25
www.alabamacommunitycare.org
Alabama Community Care
Contact Information
•
•
•
•
•
Kyle Buchanan, Executive Director
Phone: 256-265-0999
Toll Free: 844-840-2522
Mailing Address:
PO BOX 18888 Huntsville, AL 35804
Website:
www.AlabamaCommunityCare.org
26
www.alabamacommunitycare.org
Questions?
27
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