Communities Without Barriers

Coordinating Effective Care for Dual Eligibles

We will begin the webinar a few minutes after the hour to allow people to join.

Welcome & Introduction

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

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 Eligible9 million members

Medicaid51 million members

Medicare37 million members

Based on 2008 national enrollment data

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

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

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

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

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

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

Supporting Your Case Managers

Care Coordinator acts as an extension of your team

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

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

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

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

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

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

Benefits of Care Coordination Model

Improved continuity of care

Reduced service & communication fragmentation

Significant cost avoidance Improved health

outcomes

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

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

MTM is about improving members’ overall health & wellbeing by providing services to promote independence & remove barriers

to healthcare while reducing costs to clients.