Health Care Guidance Program. An update on Nevada Medicaid s Care Management Organization

Transcription

1 Health Care Guidance Program An update on Nevada Medicaid s Care Management Organization

2 What is the Health Care Guidance Program? A Mandatory program provided to a subset of Nevada Medicaid s sickest and/or highest cost, Fee-for-Service beneficiaries Originally implemented as the Care Management Organization Rebranded as the Health Care Guidance Program (HCGP) to avoid confusion between CMO and MCO Mutually Exclusive from Medicaid s Managed Care Organizations (MCO s) - (currently Amerigroup and Health Plan of Nevada, as of July 1 st Aetna Better Health of Nevada and Silver Summit Healthplan will also be providers ) - 2 -

3 Eligible members of the HCGP are flagged in the Medicaid Eligibility Verification System (EVS) as CMO CAREMGMT - 3 -

4 HCGP staff Executive Director, Cheri Glockner Medical Director, Dr. Thomas McCrorey (Ms. Glockner and Dr. McCrorey are based in Carson City with frequent visits to Las Vegas and other Nevada locations) Approx. 50 nurses, social workers, community health workers and peer specialists are dispersed throughout Nevada. Largest presence in Clark County. Serving up to 41,5000 Medicaid Members - 4 -

5 Services Provided: Disease Management Complex Care Management Nurse Advice Line Provider Quality Metrics Population Profiling Drug use Monitoring System Robust Behavioral Health Care Management Component Staff available telephonically or face-to-face Physician Portal for real time information on your HCGP Members NOTE: The HCGP is NOT an Insurance company. HCGP members have the same billing and pre-authorization rules as other Medicaid Fee-for-Service beneficiaries - 5 -

6 The HCGP is there to support you, the Medicaid provider We partner with: The Medicaid Member The Primary Care Provider The State of Nevada The Specialty and Inpatient Care Provider Our Greatest Challenge - Locating Members! - You can assist us by confirming the Member s contact information Common Problems for HCGP Members: - Social Structure Instability Shelter and Food Insecurity - Transportation Problems - Access to Specialty Care WE ARE HERE TO HELP! - 6 -

7 Barriers to Immunizations Debra Svab MHA BS RN CCM 2015 AxisPoint Health. All - 7

8 Common Barriers

9 Common Barriers Lack of knowledge: Do not know they are supposed to get a vaccination Schedule for vaccinations is not known Think they can get sick from the vaccination Thinks vaccination can cause Autism - 9 -

10 Common Barriers Unaware that the flu virus changes each year Think they got the flu from the flu vaccine Think it is too late to get the vaccination Believe that they won t get sick with the disease flu, pertussis etc

11 Pregnancy Barriers Inconsistent message

12 Pregnancy Barriers TDAP usually given in second or third trimester some patients are relating that they received it post partum in the hospital Cocooning Not seeing this promoted Influenza very mixed message Some providers their members are updated during their pregnancy other providers advise their members to not receive the influenza vaccinations while pregnant Some OB providers administer the influenza and TDAP in their offices other providers send them to public health or the pharmacy

13 Unique Barriers What we have heard from our members

14 Barriers Lack of transportation- very few members have a car that is in working order. The bus pass they receive is only for the adult and member who has the appointment

15 Barriers A call must be made to Medical Transportation Management (MTM) at least 5 days in advance to obtain an bus pass to go to an established appointment that can be verified by MTM

16 Barriers Division of care amongst providers a impaired and/or special needs child is seen frequently by many providers who is really tracking their vaccination compliance as they rarely see their PCP

17 Barriers The mother may be right by a shot clinic or at her other children s providers but they are not allowed to ride along on the transport with the disabled child per transport rules

18 Barriers Parents whose child has autism avoids the noisy shot clinics and long wait times They seek special accommodations with less stimuli

19 Other Barriers Some providers do not discuss vaccinations unless the member brings it up Few providers educate about the pneumonia vaccination for those below the age of 65 with underlying illnesses such as diabetes, asthma, HIV etc. Some shot clinics normally held at some schools were not held this fall

20 Other Barriers Parents work and cannot meet the time constraints of the clinics and providers offices Prioritization of the need for vaccinations vs the wait time vs going to the food pantry

21 Rural Barriers Mobile units come through but most of our clients do not have internet service to know the dates far enough in advance to get to the unit PCP s are limited waiting weeks for an appointment and do they do not offer shot clinics or back to school shot clinics. Some PCP s do not stock immunizations Some areas do not offer a drive through vaccination options for the flu vaccination like the do in the urban areas Some clinics have stopped giving vaccinations due to the enhanced regulations and too expensive

22 Contact Information Contact us at Enhanced HCGP website! Real Time Referral forms available at Medical Director Executive Director

23 Thank You! Please Contact us for Questions or Concerns. axispointhealth.com