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Communities Without Barriers
Coordinating Effective Care for Dual Eligibles
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Welcome and Introduction
Aaron Crowell, VP Business Development 17 years business and consulting experience
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Alaina Maciá, President & CEO
Ten year MTM veteran Implemented & led more than ten statewide & regional
non-emergency medical transportation (NEMT) programs Spearheading MTM’s expansion into new product
opportunities Member of Washington University’s Institute for Public
Health National Council
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Changing Healthcare Landscape
Healthcare reform Focus on Home &
Community Based Service (HCBS) coordination for dual eligible populations Keeping members out of
long-term care institutions and in their homes $36,000 vs. $9,000 annual
average
Dual Eligible 9 million members
Medicaid 51 million members
Medicare 37 million members
Based on 2008 national enrollment data
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Simulating the Village Lifestyle
Advancements have had unintended negative effects Back to basics solutions MTM’s HCBS model simulates the
village atmosphere Coordinated communities of HCBS
providers partner with a Care Coordinator Facilitates services that members need to
stay in their homes safely & happily
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About MTM
Established in 1995 to manage NEMT benefit for Medicaid & Medicare members Contract with credentialed local transportation providers Supported by Customer Service, Claims, Quality & Care
Management departments
18 years of experience improving health outcomes URAC accredited MO-certified WBE; IN & IL-certified affiliate
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National Footprint
Business spans 28 states
Seven million trips managed annually
Three and a half million members served every year
Five customer service centers take in three million annual calls
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Evolving with Our Clients
As healthcare evolves, MTM evolves with it to meet clients’ needs Acts as an integral part of member care plans
Expanding to new service offerings Ambulance authorizations & claims adjudication Call center education & outreach HCBS
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Leveraging HCBS to Support Members
HCBS provides services that aging, ill & disabled populations need for a healthy, happy & social lifestyle Meals Home care Home modifications Home cleaning Transportation Companionship A community-based social life
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Utilizing Quality Service Providers
HCBS provider networks are readily available but unmanaged & uncoordinated MTM’s model ensures cost
effectiveness & quality Network development staff Credentialing & training Uniforms & badges Audits & satisfaction surveys
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Supporting Your Case Managers
Care Coordinator acts as an extension of your team
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Supporting Your Case Managers
Care Coordinator connection leaves your Case Managers free to focus on clinical care Simulates the village approach Ensures quality services are provided in a timely manner Reminds members & caregivers about appointments Acts as a liaison between all involved parties Schedules & coordinates social activities
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Coordination Process
Case Manager requests in-home OASIS assessment Care plan developed in coordination with Case
Manager & medical provider Care Coordinator authorizes & arranges HCBS Services are provided Payment for service authorized
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Leveraging Technology State-of-the-art technology streamlines services Prior authorization & claims processing software Vendor management software Eligibility & encounter
data processing systems Web-based vendor
portals Smart phone apps
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Coordinated Care Case Study
Patient: Margaret Smith 78-year-old female Chronic kidney disease & diabetes Dual eligible beneficiary Hospitalized for broken hip & later discharged from a
rehabilitation facility 86-year-old husband is primary caretaker
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Mrs. Smith’s Needs
DME (walker) Home modifications to ensure access RN to manage medication Home Health Aid for bathing & light housekeeping Meal preparation/service for 60 days Transportation to medical appointments & social
activities
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Coordinating Care for Mrs. Smith
Care Coordinator augments care plan with social activities & transportation resources Call Mrs. Smith for upcoming appointments, routine
check ins & follow up on meals, medication, etc. Oversight & management of HCBS providers Real-time communication with feedback loop to
Case Manager Report outcomes & important milestones
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Benefits of Care Coordination Model
Improved continuity of care Reduced service &
communication fragmentation Significant cost avoidance Improved health
outcomes
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Proven Care Coordination Results
Studies show coordination reduces healthcare costs University of Colorado Health Sciences Center Conducted in 28 states Nearly 158,000 participants 22% to 26% decline in
hospitalizations 5% to 7% improvement in
health outcomes
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Closing
Questions? Contact MTM to learn more about how we can
partner to address gaps in HCBS delivery as you expand into new markets Free assessment of your organization’s needs
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MTM is about improving members’ overall health & wellbeing by providing services to
promote independence & remove barriers to healthcare while reducing costs to clients.