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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Quality improvement strategies
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Learning objectives
Managed care products and eligible populations
Member incentives to improve outcomes
Provider bonus programs
At the conclusion of this session, participants will be able to describe:
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Risk-based managed care delivery system
• Office of Medicaid Policy and Planning (OMPP) contracts with managed care entities (MCEs) to arrange, administer and pay for the deliveries of health care services to their members.
• The MCE is paid a capitated monthly premium for each Indiana
Health Coverage Programs (IHCP) member enrolled with the plan.
• The MCE assumes financial risk for services rendered to its members.
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Risk-based managed care delivery system (cont.)
Hoosier Healthwise
Healthy Indiana Plan (HIP)
Hoosier Care Connect
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
HIP Plus offers an enriched benefit package
HIP Plus gives members additional health care benefits:
• Dental care
• Vision services
• Adding chiropractic services beginning January 1, 2018
• No copays for Plus members (unless they seek nonemergency care in the emergency department [ED])
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
HIP Basic offers fewer benefits
HIP Basic members get fewer health care benefits:
• No dental care
• No vision services
• Copays for services
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Who runs the Medicaid program in Indiana?
• Provides regulatory framework and oversight for all state Medicaid programs
Centers for Medicare & Medicaid Services (CMS)
• Office of Medicaid Policy and Planning (OMPP) — policy and oversight of vendors
Indiana Family and Social Services Administration (FSSA)
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
• Umbrella for state health care programs administered by OMPP
Indiana Health Coverage Programs (IHCP)
• Fiscal agent — fee-for-service: DXC • Four managed care entities (MCEs): Anthem Blue Cross
and Blue Shield (Anthem)
Delegated entities
Who runs the Medicaid program in Indiana? (cont.)
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
State incentives for quality improvement HHW
Adolescent Well-Care Visits
Ambulatory Care — outpatient visit/1000
Follow-Up After Hospitalization (FUH) — within 7 days of behavioral health discharge
Frequency of Prenatal Care (FPC) — 81+ percent
Postpartum Care (PPC)
Well Child 0-15 months (W15)
Well-Child Visit in the Third, Fourth, Fifth and Sixth Years of Life (W34)
HIP
Follow-Up After Hospitalization (FUH) — within 7 days of behavioral health discharge
Adult Access to Preventive Care (AAP)
Ambulatory Care — ER visit/1000 (inverted rate)
HCC
FUH — within 30 days of discharge
FUH — within 7 days of discharge
Adult Preventive Care (AAP)
Ambulatory Care — ER visit/1000 (inverted rate)
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Provider incentive programs
2017 Negotiated Shared Savings
PQIP
BHQIP
Provider Bonus Program
2018 Negotiated Shared Savings
PQIP BHQIP BHFIP PAQCP OBQIP
New for
2018
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Provider collaboration continuum
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Mutual goals of a shared savings program
Improve clinical quality results
Empowering providers to
reach members for preventive services and
chronic condition
management
Improve medical cost management
Providing incentives and
tools so providers reduce
unnecessary utilization and
costs
Improve provider operational efficiency
Developing sustainable
workflows and processes
Promote quality, safe and effective
patient care
Improving the overall health care delivery
system
Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
2017 Provider Bonus Program
Incentive attributed to performance of specific HEDIS measures and scaled to membership — continues through Measurement Year 2017 (three installments)
Hoosier Healthwise/ Hoosier Care Connect/
HIP Emergency Room Visits (AMB-ER)
Preventive Care/ Well-Care Visits (W15, W34, AWC & AMB-OP)
Pregnancy measures for OB (FPC & PPC)
HHW/ HCC Emergency
Room Visits (AMB-ER)
Preventive Care/ Well-Care Visits (AAP)
Percentages of members seen within 90 days of enrollment
HIP
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Provider Quality Incentive Program (PQIP)
Eligibility
• 1,000 members assigned to group • Begin in January of each year
Quality measures
• Preventive care • Chronic disease management — diabetes, asthma
Access • Panel size contributes to scores
Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Behavioral Health Quality Incentive Program (BHQIP)
Behavioral health providers and community mental health centers (CMHCs)
Preventive care
• Preventive visits • Unnecessary ER use
Medication adherence
• Depression • ADHD
BH care
• Readmission prevention • Outpatient follow-up
Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Provider Access and Quality Care Program (PAQCP) New for 2018
Eligibility
• Membership level > 250 members • Availity adoption • Open-panel status • Appointment availability
Quality measures
• Preventive visits • Nonemergent ED use • Follow-up after inpatient stay
Access to care
• Nonemergent ER visits • Inpatient utilization
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Obstetric Quality Incentive Program (OBQIP) New for 2018
Overview • Incentives to participating OB providers for improved quality of care • Health plan chooses percentage of incentive to be offered
Participation criteria • Contracted and in good standing • OBQIP Letter of Agreement • Minimum of 10 attributed members
Objectives • Improved clinical quality indicators • Improved member maternity outcomes • Improved access to prenatal and postpartum care and education • Improved efficient and appropriate utilization of benefits
2018 performance indicators • Timeliness of first prenatal care visit • Overall c-section rate • Preterm birth rate • Low birth weight rate • Postpartum visit rate • Other health plan-variable indicators
Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Obstetric Quality Incentive Program (OBQIP) (cont.)
• OBQIP Incentive Payments earned by OB providers will be made within six months after the end of the Performance Measurement Period.
• A Year-End OBQIP Performance Scorecard showing the OB provider’s performance versus targets, incentive points earned and incentive payment percentage calculations will be generated five months after the end of the Performance Measurement Period to allow for claims runout and report production.
• Interim OBQIP reports will be generated periodically (no less than quarterly) and sent to the OB provider.
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
PAQCP and OBQIP next steps
• Discuss program details with your quality staff.
• Sign and return Letter of Agreement to Anthem by December 31.
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Behavioral Health Facility Quality Incentive Program (BHFIP) New for 2018
Overview
• Designed for behavioral health inpatient facilities that serve our Medicaid members with behavioral health care needs: psychiatric hospitals, freestanding mental health facilities and acute care hospitals with psychiatric units
• Rewards both absolute performance and year-over-year improvement • Year-end bonus driven by Performance Indicators
Participation criteria
• Contracted and in good standing • BHFIP Letter of Agreement • The facility must have a total of at least 100 discharged members during the Performance Measurement Period
Objectives
• Improved member outcomes • Improved member continuum of care • Improved clinical quality indicators • Improved efficient and appropriate utilization of benefits
2016 performance indicators
• 30-day readmission • Behavioral health spend per inpatient episode • Seven day follow-up visit after mental health Inpatient discharge (FUH7) • Thirty day follow-up visit after mental health inpatient discharge (FUH30) — optional • Multiple antipsychotic medications at discharge with appropriate justification overall rate (Joint Commission HBIPS-5) • Assessment of violence risk, substance use disorder, trauma and patient strengths completed overall rate (Joint Commission HBIPS-1)
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Member incentives
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Member incentive program
Engages members in their own self-care
• Receiving preventive care • Following up with care appropriately • Adhering to chronic disease care • Developing healthy habits (like smoking
cessation and exercise)
Rewards members for:
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Anthem Rewards New in 2017
Anthem will manage rewards through our claims systems. As members complete services, they are automatically entered for the reward.
Members will earn rewards for completing preventive care.
Members will receive reminders to complete preventive and follow-up care.
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Incentives for new members
Members receive $10 to complete a Health Needs Screening (HNS) within 90 days of enrollment
Members are given a variety of options to complete the HNS: • Phone • Online • Walmart Pharmacy kiosk
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Preventive visits
Members from 3 to 85 years old can receive $20 for completing their annual wellness visit.
Infants can receive an additional $50 for completing six visits by 15 months.
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Expectant mothers
• Prenatal care — Pregnant women who complete a prenatal visit in the first trimester receive $25.
• Postpartum care — Mothers who complete a postpartum visit between 21 and 56 days after birth receive the equivalent of $50.
• Smoking cessation — Pregnant women who engage and complete Indiana QuitLine sessions can earn the equivalent of up to $40.
To encourage prenatal care and promote a healthy start for a new baby, we offer multiple incentives.
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Chronic diseases
Diabetes vision screenings
$20 will be awarded annually for the completion of eye exams for members with diabetes.
HIV care Members engaged with Anthem Care Management who adhere to their medication regimen and reduce their viral load can receive up to $20 annually.
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Healthy habits
Smoking cessation — engagement • Members who engage can earn up to $20
annually.
Smoking cessation — completion • All members who smoke who engage and
complete the Indiana QuitLine sessions can earn up $20 (one time).
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Blue Ticket to Health
• Blue Ticket to Health educates families on the importance of seeing their primary medical provider (PMP) once a year, even when they are not feeling sick.
• This program is for Anthem members ages three years and older.
• Upon completion of an annual preventive visit and Anthem’s receipt of the claim from the provider, the member is automatically entered into the Blue Ticket to Health incentive program.
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Blue Ticket to Health (cont.)
Prizes
Members are eligible for over 500 prizes including:
• Visits to Lucas Oil Stadium.
• Invitations to training camps.
• Tickets to the game.
• Signed jerseys.
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Value-added benefits
Enhanced member benefits Hoosier Healthwise
HIP Plus
HIP Basic
Hoosier Care Connect
Home-delivered meals X X X
Weight Watchers® X X
No-cost pregnancy tests X X X X
High School Equivalency (HSE) test assistance
X
Boys and Girls Club membership X X
Healthy Families Program X
YMCA membership X
Personal exercise kit X
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Value-added benefits (cont.)
Enhanced member benefits Hoosier Healthwise
HIP Plus
HIP Basic Hoosier Care Connect
Retrofit X
Cellphone with 350 minutes X X X X
Community Resource Link X X X X
Youth and adult dental hygiene kits X X X
Hypoallergenic bedding X X X
Magazine subscriptions X X X X
Rides X X X X
Assistive devices X
Anthem ombudsman program X X X X
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
New team to assist members • Locate and Engage: community-
based support for members with serious behavioral needs who are most at risk for disengagement from the health care system; engages members using a person-centered approach to address key social determinants and health risk factors
• Member Liaison: helps find answers to questions members may have; serves as a mediator between members, their doctors and Anthem
• Community Health Workers: community-based support for members with chronic diseases who have unmet needs; offers education about benefits, community resources; helps members better manage their health
• Concierge Unit: call center connects members to services
• Health Educators: provide education to individuals and groups; topics range from healthy habits to chronic disease management
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Enhanced member outreach in 2017
Health education, tips and reminders and text messages —improved and new in 2017
• New technology of text campaigns added to promote preventive visits for various chronic diseases and annual preventive care such as diabetes screenings and adult preventive care
• Additional campaigns presented throughout the year with goals of enhancing member engagement
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Pregnancy care
New Baby, New Life™
Healthy pregnancy educational materials My Advocate https://www.MyAdvocateHelps.com Text for Baby Free health text messaging service Baby and Me Tobacco Free Smoking-cessation program Baby showers Events to educate pregnant women
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Member support Community Resource Link: an innovative community resource tool on the web that helps members find and apply for community and social services throughout Indiana
Transportation Services: transportation for doctor appointments, health education, WIC appointments and redetermination appointments New transportation vendor December 1, 2017
Anthem Concierge Unit: a service that helps members complete HNS, schedule appointments with their PMP, connect with community services and more
Health education: free classes available at [email protected].
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Special help
Interpreter services
• Written materials: Available in 37 languages
• Telephonic help: Call Member Services
• Face-to-face/sign language: Call Member Services to request help
• Hearing or speech loss: Call 711
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
24/7 NurseLine
The key is access: • Helps members understand their
medical condition and treatment • Helps members connect with their
doctor • NurseLine can help connect
members to an array of health care services
The goal is to promote: • Self care with information and
education • Support and care by PMP • Care coordination services • 24/7 NurseLine Hoosier Health Wise/Healthy
Indiana Plan: 1-866-408-6131 Hoosier Care Connect:
1-844-284-1797
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Member POWER Account payment assistance
• An employer or nonprofit group, like a church or foundation, can pay some or all of the member’s contribution.
• Payments can be made online at www.anthem.com/Pay4HIP.
• Just ask them to call Member Services at 1-866-408-6131 (TTY 711).
• For more information, members may visit our website at www.anthem.com/inmedicaid.
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Access and availability standards
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Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Questions/comments
www.anthem.com/inmedicaiddoc Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
AINPEC-1538-17 October 2017