Dream, Empower, Achieve!

April 26, 2012

Our ExperienceOur Experience

• Centene has 28 years experience

• Currently serves over 1.6 million Medicaid members This includes about 218,000 Aged, Blind and Disabled individuals

• Has health plans in over 15 states

Membership: 194,900

Membership: 305,800

Membership: 90,300

Membership: 36,200

Membership: 160,100Membership: 215,800Membership: 74,900Membership: 22,400 Membership: 433,100Health PlansStates with Health Plan Membership

States with Centene Operations

Implementing Health Plans

Centene Headquarters

Headquarters for CenCorp Companies

Centene Claims Processing Centers

Health Plans not yet pictured:

•Home State Health Plan (MO)

•Coordinated Care (WA)

IlliniCare’s Member with Developmental IlliniCare’s Member with Developmental Disabilities ProfileDisabilities Profile

• The “average” IlliniCare member with a developmental disability has the following characteristics: Is Male Lives in Cook County Is on average 34 years old

• Population Break Down: Sex

Male: 60% Female: 40%

County Cook: 67% Will: 10% DuPage: 8%

Lake: 7% Kane: 5% Kankakee: 3%

The Integrated Care DreamThe Integrated Care Dream

• Connecting a fragmented delivery system Bringing together medical, behavioral and social services Open communication between providers, member and health

plan

• Medical Home Member sees one Primary Care Physician and builds a strong

relationship with that provider That provider oversees health needs, helps with referrals,

specialty care, etc.

• Coordinating Care Linking members with needed services and providers Ensuring members get the right care, at the right time, in the

right setting

The Full Picture of HealthThe Full Picture of Health

Physical HealthMental Health

Social Services

Integrated Care

Making the Integrated Care Dream a RealityMaking the Integrated Care Dream a Reality

• Person-centered Care plan is unique to each member’s goals for their own health Services and programs are wrapped around the individual, customized to

their needs and preferences

• Integrated Team of Experts Assist members to navigate the system Work with current organizations/agencies as an additional advocate If members do not have this additional support, we will provide it

• Innovative Programs MemberConnections Connections Plus CentAccount

IlliniCare’s Model of Member-Centered CareIlliniCare’s Model of Member-Centered Care

Pharmacist

ConnectionsTeam

Behavioral Health

Provider

CommunityLiaison

Integrated Care Teams

24 Hr.Nurse Advice

Line

CommunitySupports

Medical PCP

MedicalDirector

MEMBER

• Behavioral Health Service Coordinator Licensed clinician with experience in

service coordination

• Medical Service Coordinator Licensed RN clinician with experience

in service coordination

Integrated Care TeamIntegrated Care Team

• Social Worker Licensed and non-licensed with experience in directly coordinating and

integrating the social/community needs of members

• Program Coordinator Helps the member navigate the system; assists in coordinating care,

setting up appointments, identifying physicians, etc.

IlliniCare currently has nine Integrated Care Teams

Integrated Care Team – Focused on Members with Integrated Care Team – Focused on Members with Developmental DisabilitiesDevelopmental Disabilities

• Specialized experience with individuals with developmental disabilities

• Each individual is touched by every member of the team

• Team works together to find solutions for members

• Noelle Ficarello, Program Specialist – Social Work 10 years of Social Services experience Licensed Clinical Social Worker Worked at residential treatment center for children with emotional and behavioral disabilities,

adults with chronic mental illness, and adults with mental illness and a developmental disability

Meet the Team:

Meet the Integrated Care TeamMeet the Integrated Care Team

• Elizabeth Audiffred, Program Coordinator 18 years experience Worked with low income families, care management and case worker programs

providing services to Medicaid enrollees

• Kathy Schneider, Medical Care Coordinator 19 years experience Registered Nurse Worked in SNF, home health care and hospice. Worked for six years as the Health

Services Director for Community Living Services at Little Friends, Inc.

• Stacey Stewart, Behavioral Health Care Manager 15 years experience Licensed Professional Clinical Counselor Worked directly with children, adolescents and adults with developmental disabilities

providing therapy and case management Providing counseling and support groups for caregivers of people with developmental

disabilities

Covered Benefits – Medical Covered Benefits – Medical • Doctor Care

Yearly Physical Exams Specialists Visits Wellness Visits Diagnosis and treatment Immunizations (shots) Prenatal and postpartum care

• Medical Supplies: Durable Medical Equipment Disposable medical supplies Prosthetic devices

• Hospital Care Inpatient services Outpatient services Laboratory X-ray Diagnostic studies Emergency care Surgeries

• Other Covered Services: Physical Therapy Chiropractic care Occupational therapy Hospice

Covered Benefits – Dental & VisionCovered Benefits – Dental & Vision

• Dental covers: Fillings Crowns (caps) Root canals Dentures Extractions (pulling)

• Vision covers: Yearly eye exam 1 pair of glasses per year

• IlliniCare Extra Benefits: Enhanced Frame Selection Contact Lenses

X-Rays Annual cleaning

for adults Practice visits if

needed

Physical Health – How We HelpPhysical Health – How We Help

PCP Relationship Assist in finding a PCP Working with providers that are

both in and out of network Educating providers on ICP,

continuity of care Annual Doctors Visits

Educate members about procedures and assist them to feel comfortable

Explain tests, next steps Practice Visits for dental services

and OBGYN appointments

Additional needs: Medical Equipment Dental Optical

Preventive Health Screenings: Flu shots Immunizations Annual pap and

mammogram Colorectal cancer

screenings

• Integrated Care Team ensures members are in good physical health. We help members with:

Covered Benefits – Behavioral HealthCovered Benefits – Behavioral Health

• Behavioral Health services include:

Mental Health assessments

Psychological evaluations

Treatment plan development

Substance abuse treatment

Crisis intervention

Therapy

Counseling

Developmental testing

Medication training

Behavioral Health – How We HelpBehavioral Health – How We Help

• Mental health affects physical health. By addressing behavioral health and medical issues together, we help members be healthier.

• Connect members with behavioral health services they need: Psychiatry Psycho-social rehab Group therapy Individual therapy

• Connecting with community agencies – the member’s local care management team Integrated Care Team doesn’t replace member’s current supports Additional advocate if needed

• Coaching – helping member understand services and process of behavioral health appointments

Medication management Substance abuse Smoking Cessation Support Groups

Covered Benefits – Pharmacy Covered Benefits – Pharmacy

• Preferred Drug List Includes list of medications that are

covered by IlliniCare. Providers must prescribe the

medications on the PDL Exceptions made if it is

medically necessary Ensure covered medications are used

to treat a variety of conditions and diseases

Entire Preferred Drug List is available online

• Over the counter drugs on preferred drug list We will cover the cost if you have a

prescription from your physician

• Filling a prescription Use an in-network pharmacy Receive 90 day supply by mail

with RxDirect

Covered Benefits – Transportation Covered Benefits – Transportation

• IlliniCare will provide transportation when needed. This includes: Reimbursement of personal mileage Door-to-Door service PACE Service Medi Transport Public Transportation

• We will select the best transportation method for the member’s needs based on: Proximity to the home/provider Accessibility needs Cost effectiveness

• Contact Member Services at 866-329-4701 to arrange transportation. Member Services will ask a series of questions to

determine the best transportation option Please contact us at least 72 hours before the

appointment

Social Health – How We HelpSocial Health – How We Help

• Having the proper support through family members, friends and the community and living fulfilling lives

• Having a safe home and access to social resources

Safety in the Home Electricity Running Water

• Providing Resources Support Groups Advocacy Organizations

Social Services Financial Assistance Housing Food Assistance

Helping Members Achieve THEIR DreamsHelping Members Achieve THEIR Dreams

• Goal Setting Part of Care Plan Not just health goals, but life goals

• Goal Examples: Following the treatment plan Going back to school – GED/College Remaining independent Living in the community Reaching their full potential Employment

• How IlliniCare helps: Coaching, guiding, empowering Finding resources Assistance in navigating the system

Empowering MembersEmpowering Members

• PCP Selection Allowing members to choose their provider

• Involved in Care Plan Creation We involve member in every step of the process along with PCP and community care team

Member’s health and personal goals contribute to overall care plan

• Coordinating Transportation Giving member the freedom and power to travel to/from their appointments

• Connections Plus Program If qualified, give member access to cell phone to connect with IlliniCare, Care Team, PCP

and familial supports

• CentAccount Program Reward members for healthy behaviors

Empower members to purchase health-related items with a pre-paid debit card

What does Integrated Care Achieve?What does Integrated Care Achieve?

• Care that is delivered at the right time, in the right setting

• Improved Health Outcomes

• Access to Preventive Care

• Independent Living in the Community

Success StoriesSuccess Stories

“I want to write, here, how happy and pleased I am with IlliniCare. I had to choose a new plan and I am so grateful I chose yours.” - Mary Y., in response to receiving the member newsletter

“I just wanted to take a quick minute and let you know, as a marketer myself, how refreshingly impressed I was. I wasn’t looking forward to having to deal with an HMO for one of our patients for PA, until I started dealing with the employees. And one that particularly stands out is Lisa Kimbrough –but they are all great. Everybody’s very efficient, they call you back, there’s no attitude; it doesn’t drag out. Blue Cross should hire your staff.” - Sharon Ballor, Applewood Rehab, Marketing & Admission Director

“It is good to know IlliniCare is so dedicated to the health of its members. Thank you as well for assisting me with this housing dilemma. As you (so rightly) said, ‘housing is a part of health.’”-Veronica, after working with the integrated care team

“He should get some sort of employee of the year award just for taking care of my problems. I can’t thank him enough for all the rigmarole he had gone through on my behalf.” - Debbie L., after working with the Integrated Care Team on behalf of her daughter, an IlliniCare member.

“We really, really do appreciate the transportation service provided through the IlliniCare Plan. You guys are way ahead of the competition. In fact, there is no competition because other companies will be following you.” - Katrina T., caregiver of IlliniCare member

Dental SuccessDental Success

Member Name: Derrick*

Stats: 23 years-old, male

Diagnosis: Autism, mental retardation and epilepsy

•Derrick’s mother contacted ICT. he was experiencing pain, fever and mouth swelling. She requested help from the ICT.

•Directed Derrick to his PCP to treat the infection; member had a tooth abscess.

•Unable to tolerate dental exam, needed IV sedation.

•Next step was to treat the abscess. Worked with the members preferred dental provider.

•SCA put into place for the member’s preferred anesthesiologist.

Terri, a program specialist with IlliniCare worked with the member and

his mother to get him the care he needed.

• The entire process involved a collaboration of the Integrated Care Team, IlliniCare management and contracting, providers, and the member's mother working together for the optimal outcome for the member.

• The end result was the member received the necessary treatment on February 22nd. 

*Members name changed to protect confidentiality

Encouragement is a part of healthEncouragement is a part of health

• Angela is a great advocate for herself, so Chris also referred her to Equip for Equality.

• Chris is currently helping Angela work with the Department of Rehabilitation in order to get the services she needs such as a homemaker and meals on wheels.

• Angela recently went to one of our members-only health events. At that event she raved about Chris, and how much he was doing on her behalf.

Member Name: Angela*

Stats: 56 years-old, female

Diagnosis: Traumatic brain injury, multiple brain aneurisms, seizure disorder

• Chris contacted Angela to complete the HRA. She was in need of DME, including a shower bar and a C-PAP machine. Chris was able to refer her to the appropriate providers to get what she needed.

• Angela did not like the PCP she was automatically assigned to, so Chris helped her find a new PCP. She has been seeing her doctor regularly, and likes him a lot.

• Angela explained that she felt lonely; she has never met someone in her situation before. Even when she spoke to others that have had an aneurism, she felt they couldn’t understand her.

• Chris encouraged Angela by explaining that she could help other people who are having a hard time recovering, since she’s been through two aneurisms. Chris gave her the information for the Brain Injury Association of Illinois, so she could join a support group. She had never considered that perspective, and is contacting them to join a support group.

Chris, a program specialist, helped a member with her

medical needs, as well as her emotional needs.

*Members name changed to protect confidentiality