HCSC’s Community Behavioral Health Links Essential to Duals Care Coordination

Relationships with community organizations that support mental health as well as recovery from addiction are essential to care coordination of Medicare-Medicaid beneficiaries, notes Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation (HCSC). These collaborations enable HCSC to address the needs of duals as “a whole sick person, and not just as a diagnosis,” she explains, noting that duals often suffer from depression along with some physical disability. HCSC also has its own integrated team with behavioral health expertise.

Julie Faulhaber shared her organization’s approach to designing a care coordination model for dual eligibles and initial findings from these new programs during a March 12, 2014 webinar Moving Beyond the Medical Care Coordination Model for Dual Eligibles, a 45-minute program sponsored by The Healthcare Intelligence Network.


Length: 4:06 minutes

Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care

If payment inequities can be addressed, communication and technology tools in place in large physician multispecialty groups make them ideal candidates for a medical neighborhood, suggests Terry McGeeney, MD, MBA, director of BDC Advisors. Dr. McGeeney, who spent 13 years of his practice career in a large multispecialty group, has also seen some FQHCs and managed Medicaid programs that do a good job of linking community and social supports required in medical neighborhoods.

As for engaging patients in this emerging integrated care delivery system, try explaining the medical neighborhood’s value proposition for them, he suggests. Patients already get why the integrated approach is good for physicians and insurance companies but need to hear why they should buy in to team care, patient portals and other aspects of centralized care coordination.

Dr. McGeeney shared his expertise in developing medical home neighborhoods during a November 20, 2013 webinar, Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care.


Length: 6:16 minutes

Dual Eligibles: Closing Care Gaps and Engaging Members in Self-Management

The philosophy that healthcare is local — and therefore, care needs to be local and community-based — forms the core of WellCare’s efforts to connect its dually eligible population to health services, explains Pamme Taylor, WellCare’s vice president of advocacy and community-based programs. The Tampa-based healthcare company takes a culturally competent approach to assessing duals’ unique personal circumstances, ensuring their “soft landing” into WellCare’s care coordination system.

Care managers at the heart of WellCare’s multidisciplinary team, conducting a comprehensive needs assessment with each Medicare-Medicaid beneficiary and driving the resulting care plan, ensuring duals’ complex care needs are met at the most appropriate time and level.

Ms. Taylor shared Wellcare’s strategies for meeting members’ needs with community-based partnerships and engaging duals in self-management of their care during an October 2, 2013 webinar, Dual Eligibles: Closing Care Gaps and Engaging Members in Self-Management.


Length: 7:16 minutes

A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings

Low scores on patient outcomes measures within the CMS Star Quality ratings program — metrics CMS weights most heavily in its assignment of stars — can typically be traced to poor provider and member engagement, notes Joseph Johnson, vice president of L.E.K. Consulting. Johnson suggests ways to enlist support from these two stakeholder groups, and describes how MA plans should prepare for the possible display in 2014 of CAHPS care coordination ratings along with with its star scores (though the care coordination ratings will not be factored into star ratings).

Johnson shared tactics to improve quality ratings as well as insight into the future direction of the CMS Star Quality program during an April 16, 2013 webinar, now available for replay: A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings, a 45-minute program sponsored by The Healthcare Intelligence Network.


Length: 7:57 minutes

Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions

An Ohio collaborative of Medicaid plans is using a rapid cycle quality improvement approach to reduce avoidable ER visits by its Medicaid beneficiaries. One of the five regions targeted by the collaborative is Toledo, Ohio — known for having the highest emergency department utilization in the nation. Mina Chang, Ph.D., of the Bureau of Health Services Research for the Ohio Department of Job & Family Services, outlines the framework of the collaborative. She explains its population-based and patient-centered approach and describes some of the priority populations targeted by the collaborative’s interventions.

Dr. Chang will describe how the collaborative is developing actionable interventions to address the patient streams most likely to use the ED inappropriately during a June 23, 2011 webinar, Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions, sponsored by The Healthcare Intelligence Network.




Length: 4:27 minutes

Integrated Case Management for Medicaid’s High-Cost, High-Need Members


Medicaid managed care organizations can turn the tide on the rising cost of care management for their high-need, high-cost members by implementing integrated programs that simultaneously address medical and behavioral health conditions, says Dr. Sam Toney, Health Integrated’s chief medical officer.

In this podcast, Dr. Toney describes how integrated case management and integrated chronic condition management are especially beneficial to Medicaid’s mostly vulnerable members as they navigate acute health crises as well as longer-term, sustainable efforts to improve their health status. For more information on Health Integrated, please visit: http://www.healthintegrated.com or call 800-323-0286.




Length: 13:36 minutes

Coordinating a Virtual Medical Home in Your Community: Lessons from the Iowa Collaborative Provider Network


To create a virtual medical home — also called a virtual healthcare home — primary care providers partner with community organizations to deliver a full continuum of healthcare services in a manner that is transparent to patients and health plan members. Sarah Dixon-Gale, lead contract manager for the Iowa/Nebraska Primary Care Association, explains how Iowa’s virtual medical home program has improved access at Siouxland Community Health Center. Also in this podcast, Siouxland CEO Michelle Stephan describes a major challenge faced by the virtual medical home. Learn how this unique community partnership helps to position these organizations for federal Medicaid expansion in 2014.


Dixon-Gale and Stephan shared more lessons learned from the virtual medical home during Coordinating a Virtual Medical Home in Your Community: Lessons from the Iowa Collaborative Safety Net Provider Network, a 45-minute webinar on September 23, 2010.




Length: 3:47 minutes