1

Improving Member Health

and Quality of Life

Rural Health Symposium

June 19, 2018

Presented by Rafielle Freeman and Cheri Moreland

BlueCare Tennessee is an Independent Licensee of BlueCross BlueShield

Association. This document has been classified as Confidential and Proprietary.

2

BlueCare Facts

Founded in 1993 as one of TennCare’s first Managed Care Organizations (MCOs)

Created as a stand-alone, for-profit subsidiary; with a separate HMO license

Employs over 900 employees, head-quartered in Chattanooga, TN, with 5 regional offices

Provide healthcare services to ~ 600,000 members

NCQA Accredited

Hold multiple contracts with the State of Tennessee

Traditional Medicaid

program providing

physical and

behavioral health

services to low-income

children, pregnant

women and disabled

individuals.

Risk-based contracts

for East, Middle, and

West Tennessee

regions.

496,295

Medicaid long-term

services and supports

program providing

nursing facility and

home-based care.

Effective July 1,

2016, ECF promotes

and supports

integrated,

competitive

employment and

independent living

skills for individuals

with intellectual and

developmental

disabilities (IDD)

11,462

Statewide program

for some of our most

vulnerable

populations such as

SSI and children in

state custody.

Administrative

Services Only (ASO)

– based contract.

35,710

Program for

individuals who are

dually eligible for

Medicare and

Medicaid. Risk-based

contract effective

January 1, 2014.

Supplemental

benefits include

dental and vision.

15,562

Children’s Health

Insurance Program

(CHIP) providing full

health coverage for

eligible children age

18 and under, as well

as pregnant women,

whose household

income exceeds

traditional Medicaid

limits.

71,039

3

BlueCare Tennessee

Products and Populations

CHOICES/

Employment &

Community

First (ECF)

CHOICES

TennCare

Select

BlueCare

Plus

Dual Special

Needs Plan

(DSNP)

CoverKidsBlueCare Core

Risk

4

BlueCare Tennessee Membershipas of 5/11/18

5

BlueCare Tennessee Mission

Member Outreach

6

Member Outreach is an activity of providing services to our populations who

might not otherwise have access to those services.

7

What is different about Medicaid managed care?

To improve population health “it’s the housing, it’s the lack

of access to food, it’s the broken families, it’s all that messy

stuff. It’s a complex story so it can’t have a medical fix to

make it work.”

Dr. David B. Nash

Dean of the Jefferson School of Population Health

8

Educate & Encourage our MembersTo Improve Outcomes

TennCare KidsEPSDT

9

TennCare Kids is a full program of checkups and health care services for children

from birth through age 20 who have TennCare. These services make sure that

babies, children, teens, and young adults receive the health care they need.

TennCare Kids – EPSDT Membership and Goal

10

BlueCare Tennessee provides health plans to more than 353,000

members under the age of 21.

Our goal is to assure that children get the

health care they need when they need it

• The right care, to the right child, at

the right time, in the right setting

Address health problems before they

become advanced and treatment is more

difficult and costly

This can be accomplished with your help through their EPSDT Screenings

TennCare Kids – EPSDT EPSDT Defined

11

EPSDT Definition: The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit

provides comprehensive and preventive health care services for children under

age 21 who are enrolled in Medicaid.

Early – Assessing and identifying problems early

Periodic - Checking children's health at periodic, age-appropriate intervals

Screening - Providing physical, mental, developmental, dental, hearing,

vision, and other screening tests to detect potential problems

Diagnosis - Performing diagnostic tests to follow up when a risk is identified

Treatment - Control, correct or reduce health problems found

TennCare Kids – EPSDT 2015-2017 CMS-416 MCO Averages

12

TennCare Kids – EPSDT CMS-416 Yearly Rate Comparisons –Middle

13

MiddleCounty 2016 2017

Bedford 66% 78%

Cannon 58% 62%

Cheatham 72% 78%

Clay 61% 63%

Coffee 67% 76%

Cumberland 79% 83%

Davidson 77% 82%

DeKalb 57% 63%

Dickson 62% 66%

Fentress 60% 68%

Giles 68% 70%

Hickman 61% 72%

Houston 62% 65%

Humphreys 64% 72%

Jackson 72% 75%

Lawrence 69% 81%

Lewis 64% 69%

Lincoln 56% 62%

Macon 64% 73%

MiddleCounty 2016 2017

Marshall 71% 83%

Maury 70% 77%

Montgomery 69% 78%

Moore 69% 77%

Overton 59% 70%

Perry 53% 56%

Pickett 70% 78%

Putnam 80% 86%

Robertson 74% 82%

Rutherford 67% 77%

Smith 63% 66%

Stewart 57% 64%

Sumner 63% 71%

Trousdale 64% 71%

Van Buren 68% 65%

Warren 60% 65%

Wayne 67% 75%

White 77% 82%

Williamson 66% 71%

Wilson 67% 75%

Increased = 38Decreased = 1No Change = 0

TennCare Kids – EPSDT CMS-416 Yearly Rate Comparisons –West

14

WestCounty 2016 2017

Benton 76% 84%

Carroll 72% 85%

Chester 57% 61%

Crockett 69% 73%

Decatur 55% 63%

Dyer 83% 86%

Fayette 66% 73%

Gibson 66% 68%

Hardeman 56% 63%

Hardin 53% 56%

Haywood 52% 62%

Henderson 59% 65%

Henry 68% 71%

Lake 64% 73%

Lauderdale 59% 70%

Madison 60% 61%

McNairy 52% 57%

Obion 64% 76%

Shelby 68% 71%

Tipton 64% 64%

Weakley 68% 74%

Increased = 20Decreased = 0No Change = 1

TennCare Kids – EPSDT CMS-416 Yearly Rate Comparisons –East

15

EastCounty 2016 2017

Anderson 62% 65%

Bledsoe 64% 65%

Blount 66% 70%

Bradley 61% 63%

Campbell 74% 76%

Carter 70% 77%

Claiborne 59% 64%

Cocke 78% 85%

Franklin 65% 70%

Grainger 65% 70%

Greene 64% 76%

Grundy 58% 63%

Hamblen 76% 80%

Hamilton 62% 66%

Hancock 75% 84%

Hawkins 64% 75%

Jefferson 72% 76%

EastCounty 2016 2017

Johnson 65% 69%

Knox 64% 68%

Loudon 70% 77%

Marion 58% 58%

McMinn 74% 76%

Meigs 77% 75%

Monroe 69% 76%

Morgan 64% 65%

Polk 58% 57%

Rhea 64% 69%

Roane 74% 68%

Scott 62% 62%

Sequatchie 57% 65%

Sevier 69% 78%

Sullivan 65% 70%

Unicoi 81% 84%

Union 68% 72%

Washington 74% 81%

Increased = 30Decreased = 3No Change = 2

16

Community Care Partners

Alisa JohnsonCommunity Care Partner (CCP)Office: 423-854-6048Cell: 423-413-5557Email: Alisa_Johnson@BCBST.com

Sylvia StamperCommunity Care Partner (CCP)Office: 423-535-8172Cell: 423-255-6875Email: Sylvia_Stamper@BCBST.com

Jasmine DaryCommunity Care Partner (CCP)Office: 423-535-8108Cell: 615-393-1386Email: Jasmine_Daryl@BCBST.com

Shanae CarrawellCommunity Care Partner (CCP)Office: 901-544-2302Cell: 901-302-0820Email: Kiawanna_Carrawell@BCBST.com

Shenece Craddock Community Care Partner (CCP)Office: 423-535-7427Cell: 423-463-2984Email: Shenece_Craddock@BCBST.com

17

Strategies to Promote Event Attendance

Telephone Calls

Postcards

Website Postings

Facebook/Instagram

Flyers

Incentives

Fitness Events

18

Advisory Panels & Workshops

19

20

Meet Members Where They LiveCommunity & Health Equity Advisory Panels

Regional Priority:Opioid Use Disorder

Regional Priority: EPSDT

Regional Priority:TBD

Regional Priority:Social Service Exchange

Purpose:The role of the BlueCare Tennessee’s Community and Health Equity Panel is to drive movement toward health equity in and between communities across the state.

+ BlueCare team has assembled a set of Community and Health Equity Advisory Panels in four regions of Tennessee: Upper East, Lower East, Middle and West.

+ These groups include BlueCross and BlueCare leaders, along with physicians and representatives from community agencies in those regions

+ BlueCare and its partners are tackling different health needs in different ways, because the populations in each part of Tennessee face unique challenges

+ BlueCare is taking a collaborative approach to better understand how those challenges are playing out in real life for the residents of those regions

21

Meet Members Where They LiveCHOICES Advisory Panels

East Region: CHOICES Advisory Board

Middle Region:CHOICES Advisory Board

West Region:CHOICES Advisory Board

Purpose:The role of the BlueCare Tennessee’s CHOICES Advisory Panel is to create a forum where members, member representatives, advocates and providers offer input and recommendations regarding BlueCare Tennessee’s program, policies and procedures.

+ The CHOICES Advisory Group provides input into BC/TCS’ planning and delivery of long-term support services, CHOICES Quality Management/Quality Improvement activities, program monitoring and evaluation, as well as member, family and provider education

+ BC/TCS provides orientation and ongoing training for Advisory Group members in order for them to have sufficient information and understanding of the CHOICES program to fulfill their responsibilities

+ Additional Panels include ECF CHOICES Advisory Panel and Behavioral Health Advisory Committee

Resource Parent Education

22

Insurance should be the least

of our parent’s worries. They

should never wonder about

which path to go in terms of

the child’s healthcare. We

want to provide support.

Strengthen Resource Parent awareness of our programs and services

Offer curriculum for inclusion in the Resource Parent Training Program

Improve the Resource Parent Experience regarding Access to Care

Promote Healthy Lifestyles and Explore Opportunities to Address Gaps in Care

Community Partnerships

23

Community Partnership EngagementGoals and Rational

24

Goal

Our Community Engagement Strategy focuses on building relationships with community agencies, stakeholders, civic organizations and interest groups to work side-by-side as long-term partners—building a coalition of support for BC/TCS programs, initiatives, policies, and services—with the end goal of improving the quality and efficiency of care for BlueCare members statewide and making the community a better place to live.

Rational

• Allows us to enhance the shared BlueCare Community Care Model by tapping into diverse resources, programs, services and activities to improve the quality of members lives.

• Promotes a wide variety of community interactions that range from information sharing, accessing and sharing resources, population assessments, to community consultation, community outreach events, referral services and in most instances, active participation in decision-making processes.

• Empowers those from the community to learn about our initiatives and programs that support our operational goals including NCQA, EPSDT, and HEDIS /CAHPS, allowing them to see multiple sides and increasing the likelihood that initiatives and/or solutions will be widely accepted.

• Increases the level of trust between communities and our organization.

Provider Education & Engagement

25

Provider Tools

26

Provider Administration Manual

Monthly BlueAlert Newsletter Articles

Quality Newsletters

Clinical Practice Guidelines

Website Resources including Billing Guidelines and Toolkits

Collaboration with the Tennessee Chapter of the American Academy of Pediatrics, Tennessee Primary Care Association and Tennessee Hospital Association

Annual All Blues Workshops

Annual Tennessee Medical Association Workshops

Annual Vaccines for Children Workshop

Various Provider Conferences

Provider Tools

27

Community Mental Health Center Initiatives

Medical Record Audits

Behavioral Health Resources

• Referral Assistance Line

• Primary Care Provider Consultation line

• State of Tennessee Crisis Hotline

• PCP Behavioral Health Tool Kit

Other techniques and tools

• Appointment Faxes

• Pediatric Initial Health Assessment Forms

• PCP Membership Listing

• Referral to Specialist / Care Coordination /IEP / EBLL

Enhanced Training BEHIP

28

BEHIP Behaviorally Effective Healthcare In Pediatrics

Collaborative training program between BlueCare and TNAAP to educate pediatric PCPs to

• Use tools and strategies to screen for, assess, and manage patients with emotional, behavioral, and substance abuse challenges

• Use helpful, natural language with patients regarding screening results

• Know and access behavioral resources

Enhanced Training BEHIP

29

Available online

Free and will earn up to 5.25 AMA PRA Category 1 credit(s)

To access the online training modules, visit http://www.tnapp.org/behip and look for the online training modules link

Provide pediatric healthcare provider with tools and strategies to screen for, access and manage patients with common behavioral health concerns

Modules range from 30 minutes to 1 hour, covering the following topics:

• Module 1: Introduction to Behavioral Health Pediatrics

• Module 2: Postpartum Depression

• Module 3: Disruptive Behavior

• Module 4: Inattention

• Module 5: Anxiety

• Module 6: Depression

• Module 7: Substance Abuse

• Module 8: Workflow and Coding

Provider Quality Engagement Strategy

30

Achieving successful patient outcomes is directly impacted by Provider Engagement. To accomplish this evolving focus on quality, Health Plans across the nation have evolved their quality improvement portfolio by partnering with primary care providers through Pay for Quality programs.

Quality-based purchasing strategies aim to better coordinate a variety of quality improvement efforts toward a shared set of priorities that focus on core populations. This is especially relevant for Medicaid MCOs.

Successful quality-based program implementation and thus effective provider engagement includes identification of performance indicators which are:

Resources:

HealthChoice and Acute Care Administration Division of HealthChoice Management and Quality Assurance (2012). Medicaid Managed Care

Organization Value-Based Purchasing Activities Report. Retrieved from https://mmcp.dhmh.maryland.gov.

Optum (2015). Provider engagement has a major impact on quality, costs and outcomes. Retrieved from http://www.optum.com.

Provider Quality Engagement Strategy

31

The essential elements to provider engagement with the goal to improve quality and member health outcomes include the following:

Increased adoption of gap closure activities

• Provided the right resource tools and application, providers can use decision support to close applicable member gaps in care. Said systems offer providers near-time access into patient profiles and most importantly into integral gaps in care reports. Such essential patient information helps providers to ascertain a much more holistic view of their patients’ health status and provide a greater impact on overall patient health outcomes.

Use of data-driven best practices

• Knowing the right questions to ask and being able to tap into data-driven insights leads to more targeted interventions for patients and more efficient use of a provider’s time. It also decreases unnecessary tests and treatments, increasing provider and health plan financial performance.

Improved use of decision-support tools and thus increased interoperability

• A complete view of the patient’s prior care is essential to improving care and reducing unnecessary treatment. Providers must be able to quickly view medical records, regardless of where they are located and what electronic health record (EHR) they were created in.

Tennessee Health Care Initiative Innovation

32

3 Strategies:

Primary Care Transformation• Patient Centered Medical Home

• Tennessee Health Link

• Care Coordination Tool

Episodes of Care

Long Term Services and Supports

Tennessee Health Care Initiative Innovation

33

PCMH model includes the following:

Patient-Centered Access: Providing same-day appointments for routine and urgent care

Team-Based Care: Conducting scheduled patient care team meetings or a structured communications process

Population Health Management: Using risk stratification to address chronic and acute care services and perform outreach activities

Care Management Support: Identifying high-need, high-risk patients for care management and developing care plans with self-care support recommendations

Care Coordination and Care Transitions: Tracking referrals; completing follow up and coordination of care transitions

Performance Measurement and Improvement: Measuring and tracking quality and efficiency metrics

Improvement Design

• Transformational Activities with:

• Large, low performing practices

• Large, almost ready practices

• Clinical Data Exchange Oversight

• Value Based Program Design

• Quality Metrics

• Financial

• Qualitative review of provider performance reports

Tools & Resources

• Quality Care Rewards Tool improvement and metrics

• Quality Materials

• Quality Improvement meeting collaboration with Navigant

• BCBST PCMH Consultant Collaboration

TennCare Coordination

• Strategic Decision Making

• Quality Measure Selection

• Quality Measure Accuracy

• Collaborate with non-PCMH providers to promote treatment opportunities to improve gap closure

• Cross functional education and training for PCMH/THL

34

BlueCare’s Role in Primary Care

Transformation

35

Provider Engagement & Incentive Team

Provider Scorecard

Provider Performance Reports

Provider Reports

Provider Engagement

Provider Resources

Substance Use Disorder Initiatives

36

+ Opioid Stewardship and Safety

+ Best Care for Substance Use Disorder (SUD)

+ Medication-Assisted Treatment (MAT) Expansion

- Challenge embraced by BlueCross

- Very high priority set by Governor Haslam

- https://www.tn.gov/governor/news/2018/1/22/haslam-announces-aggressive--comprehensive-plan-to-end-tennessee-s-opioid-epidemicemic.html

- Priority strongly re-affirmed by TennCare

- https://www.tn.gov/tenncare/tenncare-s-opioid-strategy.html

- Partner with TN Together

- https://www.tn.gov/opioids

+ Tele-Education: Project ECHO

Questions

37

Local SOLUTIONS,

Meaningful RESULTS