Magellan Complete CareThe Florida Medicaid specialty health plan that helps members get quality care for their mind & body.

OPEN MINDS Performance Management InstituteCEO MCC FL Manny Arisso, JD LHRM

Agenda Magellan Health :Mission and Vision

Magellan Complete Care: Who we are, Why we are, Where We are

First SMI Specialty Plan: Integrating Care for Success

Our Members

Our Model: Member Focus

Integration: The Partnership

Questions

Integration and Innovation working towards system transformation 

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Why We’re Here‐Magellan Health

VISION Sparking innovation to build healthier and brighter futures

MISSIONMagellan guides individuals to make better decisions, and live healthier and more fulfilling lives, by improving the overall quality and affordability of healthcare.

GUIDINGPRINCIPLES

Member focused Provider partnerships Innovation oriented Passionate and responsible stewards         Committed to the communities we serve.

Big NOBLE Purpose

Magellan HealthcareMagellan Healthcare• Behavioral health and substance abuse

• Integrated medical and behavioral care 

• EAP and employer health and wellness

• Psychotropic drug management

• DOD/VA Programs• Magellan Complete Care

• Behavioral health and substance abuse

• Integrated medical and behavioral care 

• EAP and employer health and wellness

• Psychotropic drug management

• DOD/VA Programs• Magellan Complete Care

NIA MagellanNIA Magellan• Advanced and non‐advanced imaging 

• Cardiac • Radiation oncology• OB ultrasound • Emergency department• Pain management• Sleep management

• Advanced and non‐advanced imaging 

• Cardiac • Radiation oncology• OB ultrasound • Emergency department• Pain management• Sleep management

Magellan RxMagellan Rx• Pharmacy benefit administration

• Medicaid formulary management

• Pharmacy claims administration

• CMS and supplemental rebate management

• Medical pharmacy• Specialty pharmacy

• Pharmacy benefit administration

• Medicaid formulary management

• Pharmacy claims administration

• CMS and supplemental rebate management

• Medical pharmacy• Specialty pharmacy

Who We Are ‐Magellan Health

Magellan Health is a healthcare management company that focuses on fast‐growing, complex and high‐cost areas of healthcare, with an emphasis on special population management.  Magellan collaborates with providers to improve the health and well‐being of  individuals and lower the cost of care.

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Magellan Complete Care

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The Case for Change

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Limited EngagementFragmented CareInequitable Access

Poor OutcomesCostly Programs

Personalized CareIntegrated Programs

24 / 7 AccessPositive OutcomesCost Effectiveness

Why We Are

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Saw a Need:Innovation in Integration

Policy Driven:Looking for the right solution.

Local Focus: Bottom Up Approach

Change: Working together to improve delivery of care

Member Focus

Magellan Complete Care …

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a unique offering that is specifically designed and focused to holistically care for individuals with chronic conditions .

a line of business separate from Magellan Behavioral, providing the full services of a Managed Care Organization.

a separate and distinct Strategic Business Unit at Magellan focused on the complete care of individuals. 

a licensed Health Plan that manages integrated medical and behavioral health service.

IS the stapling together of Magellan Behavioral Health and some physical health management resources.

an extension of our current behavioral health programs that exist across the America..

IS NOT

Who We Are

Magellan Complete Care focuses on delivering a unique model to those most in need.

Health Plan

Magellan Complete Care is devoted to helping members feel better and enjoy a healthy life. 

Our Commitment

Magellan Complete Care delivers and guides you through quality care for your mind and body

We Deliver

Where is Magellan Complete Care Today?

IOWA NEW YORKFLORIDAIn Iowa, MCC developed Integrated Health Homes. In these patient‐centered medical homes, MCC partners with community mental health centers and local federally qualified health centers to better coordinate behavioral and physical health services. Based on the success of pilot, the IHH program was expanded statewide with Section 2703 of the Affordable Care Act’s Integrated Health Home provision. 

In Florida, MCC was selected  to launch a Medicaid specialty health care plan that manages the medical and behavioral health benefits for individuals with SMI. The first of its kind in the nation, MCC has developed a results‐driven, community‐based approach to holistically address the health care needs of these special individuals. 

In New York, MCC’s majority‐owned health plan is a Medicaid Managed Long‐Term Care Plan designed for chronically ill and disabled individuals who want to continue to live in their home, but need assistance with day‐to‐day health activities.  

Beginning 1/1, MCC is participating in the New York Fully Integrated Duals Advantage (FIDA) Duals Demonstration Program. 

Integrated Health Homes Nation’s 1st SMI Specialty Plan

MLTC, Medicare and Duals

FLORIDASMI Specialty Plan

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Magellan Complete Care ‐ Florida

Magellan Complete Care understands the unique mental and physical health needs of individuals living with Severe Mental Illness (SMI). 

Our goal is to ensure that all members receive personalized, high‐quality healthcare that is tailored to their medical, mental health, and social needs.

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Magellan Complete 

Care

Magellan Complete 

Care

SMISMI

Chronic Health Issues 

Chronic Health Issues 

Social NeedsSocial Needs

Magellan Complete Care ‐ Goals

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• Improve the overall health, longevity and well‐being of the members living with serious mental illness

• Improve the overall health, longevity and well‐being of the members living with serious mental illness

ImproveImprove

•Providing better access, care coordination, and individual and family support for this special population 

•Providing better access, care coordination, and individual and family support for this special population 

ProvideProvide

•Decrease overutilization of institutional or facility‐based care and increase community tenure for these individuals 

•Decrease overutilization of institutional or facility‐based care and increase community tenure for these individuals 

DecreaseDecrease

•Create system transparency and accountability through data  sharing and outcome tracking 

•Create system transparency and accountability through data  sharing and outcome tracking 

CreateCreate

Eligibility 

In order to be eligible for enrollment in Magellan Complete Care in Florida, applicants must have Medicaid benefits.

And be living with a Serious Mental Illness (SMI). 

• Psychotic Disorders • Bipolar Disorders• Major Depression • Schizo‐affective Disorder• Obsessive‐compulsive Disorder • Delusional Disorder 

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Effective 9/1 (Auto Assignment)Regions 2, 4, 5, 6

Effective 7/1Areas 10, 11

Effective 8/1Areas 7,9

JACKSON

CALHOUN

GADSDEN

GULF

LEON

WAKULLA

ALACHUA

BAKER

BAY

BRADFORD

BROWARD

CHARLOTTE

CITRUS

CLAY

COLLIER

DADE

DE SOTO

DIXIE

DUVAL

ESCAMBIA

FLAGLER

GILCHRIST

GLADES

HAMILTON

HARDEE

HENDRY

HERNANDO

HOLMES

INDIAN RIVER

JEFFERSON

LAFAYETTE

LAKE

LEE

LEVY

MADISON

MANATEE

MARION

MARTIN

MONROE

OKALOOSA

PALM BEACH

PASCO

PINELLAS POLK

PUTNAM

ST. JOHNS

SANTA ROSA

SARASOTA

SUMTER

SUWANNEETAYLORUNION

VOLUSIA

WALTON

LIBERTY

ORANGE

OSCEOLA

NASSAU

Region 2:  Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, Washington

Region 4:  Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia

Region 5:  Pasco, Pinellas

Region 6:  Hardee, Highlands, Hillsborough, Manatee, Polk

Region 10:  Broward

Region 11:  Miami‐Dade, Monroe

Region 7:  Brevard, Orange, Osceola, Seminole

Region 9:  Indian River, Martin, Okeechobee, Palm Beach, St. Lucie

MCC Florida Regional Map

Our Benefits

Member 

Magellan Complete Care has many doctors and nurses who help our members keep good health. Your primary care physician (PCP) is your doctor that will manage all your health care. 

Magellan Complete Care has a network of doctors, therapists, counselors and peer specialists who can help you with serious mental illnesses.  They include:

Obsessive‐compulsive disorder  Bipolar disorder 

Schizophrenia  Depression 

Magellan Complete Care has a list of drugs your doctor can pick. The covered medicines include prescription and certain over‐the‐counter medicines. You can get prescriptions filled at a lot of pharmacies in our network.

Magellan Complete Care helps you with regular dental care to fight and prevent gum disease and cavities.

Magellan Complete Care vision services include eye exams, eyeglasses, and contact lenses, if needed. 

Magellan Complete Care has programs to help you better understand and care for your chronic conditions. They include:

Asthma Congestive Heart Failure 

Diabetes Cancer and Cancer Prevention

Magellan Complete Care can get you transportation to and from your medical, dental appointments and the pharmacy.

Enhanced/Expanded Benefits

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•Primary care visits for non‐pregnant adults•OB visits for routine pregnancy•Dental for adults •Vision services

General Health

•Home health visits for non‐pregnant adults•Intensive out patient for Substance Use disorder•Outpatient hospital services benefit expansion

Home Health & Out Patient

•Nutritional counseling•Post discharge meals•Healthy Behaviors Program

Nutrition

•Pneumonia, flu and shingles shots•Monthly benefit for over the counter products

Vaccines, Over the Counter Medication & Supplies

Our MembersThe Need

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Why we do what we do

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1 5in

Americans lives with mental health challenges

Why we do what we do

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60%of adults with any mental illness

are untreated

Why we do what we do

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40%of adults living with serious mental illness

receive no treatment

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40

60

80

100

Our Focus ‐ SMI Population 

Higher rates of modifiable risk factors

• Smoking • Alcohol consumption • Poor nutrition • Lack of exercise • Unsafe sexual behavior 

Complex relationship between SMI and 

medical conditions 

• Interplay of drugs and conditions• Unaddressed physical health issues causing higher anxiety

Symptoms associated with SMI can impede getting 

needed care 

• Feelings of hopelessness and powerlessness• Fear of accessing care• Difficulty in following medical recommendations• Decreased motivation• Impaired communication skills

Alcohol and substance use disorders 

• Co‐occur in 40 to 70% of individuals with SMI

Impact of psychotropic medications

• Cause metabolic syndrome, weight gain, and diabetes• Side effects can mask symptoms of medical illnesses

High rates of chronic medical conditions

• Cardiovascular disease• Diabetes • Obesity • Respiratory disease• Infectious disease• Musculoskeletal problems

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Comorbidity ‐ Creates the Need for Integrated Care

24%

34%

18%

35%

64%

0%

10%

20%

30%

40%

50%

60%

70%

SUD Respiratoryproblem

Diabetes Heartdisease

Obesity

Incidence of chronic co‐morbid medical conditions SMI

11% 

62% 

27% 

SMI with multiple chronic conditions

Zero Conditions1–2 Conditions3+ Conditions

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Note: Prevalence rates of specific physical health conditions. n=12,385. Dark green data represents prevalence for general population in Arizona in 2011. 

Note: Represents percentage of population with SUD, respiratory problems, diabetes, heart disease and/or obesity. n=12,385.

SMI Cost Profile Claims Data Set

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SMI Cost Profile: Top 3%Members

FFS PMHP Total FFSClaims Enctrs Expense Claims

Inpatient Physical Days / k 2,720 2,720 26,456ALOS 5.9 5.9 6.6PMPM $347 $347 26% $4,513 53%

Inpatient Behavioral Days / k 994 652 1,646 6,951ALOS 5.5 4.2 4.9 5.5PMPM $128 $50 $178 13% $1,098 13%

Emergency Room $70 $70 5% $239 3%

Outpat / Prof Physical $274 $274 20% $1,360 16%Outpat / Prof Behavioral $51 $71 $122 9% $124 1%

Rx Physical $209 $209 15% $979 11%Rx Behavioral $160 $160 12% $206 2%

Total PMPM $1,239 $121 $1,360 $8,517

Share of Total Spend 91% 9% 100% 30%

Our Commitment to Our Members

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CommitmentCommitment

Help navigate the system to reduce or eliminate barriers 

for enrollees

Identify and address attention to high‐risk enrollees

Support members in self and health management and treatment adherence

Improve members’ ability to self‐manage chronic 

conditions

Achieve healthy, meaningful lives

To Help AvoidTo Help Avoid

Adverse drug interactions

Duplicate tests

Frequent, unnecessary ER visits

To Improve Risk Factors

To Improve Risk Factors

Hypertension

Weight

Exercise

Glucose levels

Our ModelThe Difference

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Innovations in Action‐Model of Care Elements

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IntegratedHealthHome

MYLIFE

Peer Programs

Individualized Care Plans

Housing Programs

Self Directive

Care

Information SharingProvider

Network and

Payments

Smoking Cessation

Linkages to Social

Services

Field Staff Model (2/3)

Crisis Navigator

Mobile PhoneProgram

Care Coordination

Teams

Suicide Deterrent Jail

Diversion CIT

Whole Health Rx

Magellan Complete Care’s enhanced services result in a unique model of care tailored for this population that requires that we work much more collaboratively to share information, coordinate care, and provide support for the enrollees and providers.

Members of the Care Coordination Team

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We help members make appointments, arrange transportation to appointments, and adhere to treatment regimens. 

Our peer support programs can help support the member’s health and wellness between appointments.

Resulting in improvement to the member’s overall health –mental and physical.

Provider Support

Specialists

Social Services

Network Contracting

Community Partnership

Community Outreach

Specialists

Provider Liaison

Personalized careClinical excellence

Person‐Centric Systems of Care for Better Health

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Communitypartnerships

Multi-modal

Riskstratification

Culturallycompetent

Value-based

networks

Integratedsolutions

BestOutcomes

Network Project-Worked with Medical Center to address credentialing needs

-Built a meaningful relationship with the practice via high touch approach

- Resolved contracting issues through teamwork

Engagement

CMHC Outreach-Outreached during CMHC project

- Locations in South Florida

- Working collaboration

- Provider educated me on their agency

- Staff explained the companies vision to expand services in Palm Beach county

Needs Assessment

PCP Outreach-Continued to meet with Medical Center to assess their readiness for an integrated model of care (SRA: 4.8)- Met with practice staff to build rapport and educate - Asked questions to understand the practice, their goals and strengths- Identified a large unmet mental health need (on avg. they have 1 Baker Act per week in their office)

Supportive Growth

Making the Connection-Collaborated with Medical Center to explore options to meet this critical patient need - Provider explained their “vision” for a solution based on their patient population, and current resources- Explained the spectrum of services by CMHC provides, location and goals for expansion- Connected the 2 providers to match their needs and goals

Connecting the dots… Provider Support SpecialistSeeing an opportunity for partnership every step of the way

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Teamwork

Case study for integration

Health Guide: Boots on the Street Impacting Lives

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Building ConfidenceHeart Condition, Bipolar, Smoker,Housing Instability…• ICCP, Setting of goals• PSS, Medication Adherence• PSS, PCP Appointments

Member empowerment.• Rx Adherence• PCP Visits• ER Reduction• Access to Dental Care

“I care because you are caring, thank you for caring.”

Building Member trust, sharing information, member advocacy.• Integrating Care via 

sharing information.• Building awareness.• Member in care.

“You are the reason I feel motivated to change”

“I never get treated so

well!”

“She saved my life”

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Faceto Face

Integration:The Partnership

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Channels for Integration

Community

• Incentive/Integration  Based Contracts

• Model of Care Integration• Information Hub‐ PSS/HG• ICT Meetings• Data & Analytics

• SAMHSA Integration Projects • Incentive Based Payments

• Coordination• Co‐Location• Integration

• Information Sharing

Member FocusBetter Outcomes  

Improved HealthIncrease Tenure

Expand Delivery

Providers

MCC

• Linkages to Social Services • Community Outreach• Sharing of needs and supports.

First Lessons‐ Tearing down barriers for integration

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THIS IS REALLY HARD– CHANGE IS HARD

Co-Location

Does not mean coordination

Benefits soar beyond just health care

• Children Self harm behaviors dropped by 7%

• Caregivers absence at work dropped by 13%

• School attendance improved by 12%,children missing >2 days

DO IT LOCAL

Local community partnerships are

essential for integration.

The power of stigma, the need for education.

Working with Providers

Magellan Complete Care supports providers with services that help coordinate care, implement self‐care practices, and improve adherence to treatment plans for members living with SMI.

• We offer a fully integrated service model, information sharing

• We emphasizes prevention and early intervention, routine screenings, and whole health peer support to keep members healthy.

• Specialized chronic care improvement program for the diagnosed condition of the member.

• We  assist with members getting appointments and in the process train and equip the internal practice staff on how to deal effectively with these individuals.

•We strive to simplify the delivery and administration of care so providers can do what they do best—treat patients and improve care.

Our Commitment to Our Providers

CollaborationCollaboration

We facilitate and coordinate care and treatment planning

Support for your practice to improve outcomes

Improved health care experience for enrollees

Alignment Alignment 

Incentives with providers

Health assessments

Aftercare support

Care coordination

SupportSupport

Timely, accurate claims payment

Customer service and physician liaison

Member self‐management, education and healthy living

Dedicated provider support team

Comprehensive, online tools for easy plan administration

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Q & A

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