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MLTSS

MLTSS. Kristin Murphy. Who is the membership? . The MLTSS population consists of dual eligibles who have opted-out of MMAI and who are either residing in nursing facilities or receiving waiver services. Chicagoland: 26,729 new members (LTC and waiver) across 6 health plans

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MLTSS

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  1. MLTSS Kristin Murphy

  2. Who is the membership? • The MLTSS population consists of dual eligibles who have opted-out of MMAI and who are either residing in nursing facilities or receiving waiver services. • Chicagoland: 26,729 new members (LTC and waiver) across 6 health plans • 9,958 LTC members and 16,771 waiver members • If all things are equal across plans: • LTC: 1660 members • Waiver:  2795 members

  3. Preparation for new membership: • Letters being mailed in waves, with the first in June • 60 days to pick a plan, then auto-assignment • July will be for opt-in membership and those selecting Illinicare Health • Increase staffing to cover membership • Contract is expected to run through 12/31/19 at earliest

  4. 10 Essential Elements • Adequate Planning and Transition Strategies • Stakeholder Engagement • Enhanced Provision of Home and Community Based Services • Alignment of Payment Structures with MLTSS Programmatic Goals • Support for Beneficiaries • Person-Centered Process • Comprehensive and Integrated Service Package • Qualified Providers • Participant Protections • Quality

  5. Best Practices LOCAL APPROACH • quality healthcare is best delivered locally • provide accessible, high quality and culturally sensitive healthcare services to our members • care coordination model utilizes integrated programs that can only be delivered effectively by a local staff • focus on diversity of staff and provider relationships to serve membership, bridging social, ethnic and economic gaps. CARE COORDINATION • partnerships with its trusted providers to ensure members receive the right care, in the right place, at the right time

  6. Best Practices continued HEALTHCARE COMPLIANCE • State and Healthcare Effectiveness Data and Information Set (HEDIS) reporting constitutes the core of the information base that drives our clinical quality performance efforts. This reporting is monitored by Quality Improvement Committees • Cultural Sensitivity We successfully coordinate care for our diverse membership by recognizing the significance of the many different cultures our members represent and by forming partnerships in communities that bridge social, ethnic and economic gaps.

  7. Our Model • Engaging Independent Living Centers and Area Agencies on Aging within the community • Caregiver support services • Direct care workforce initiatives (training, recruitment, retention) • Behavioral health and disease management integration • Local care coordinators as point of contact • Educational and training sessions for members, providers & staff

  8. Person-Centered Model • Creative and flexible style targeted at functional status • Link consumers and families to medical and non-medical community resources • Educational & vocational services, assistive technologies, out of home care and family support to meet their needs, while providing coordinated health care • Full, coordinated benefit coverage and value added features • Local “boots on the ground” approach • Identify barriers • Facilitate communication across medical and behavioral health specialties • Coordinate services, including transportation and referrals

  9. Provider Network • Non-traditional Providers: • LTSS Providers • Day Services • Respite • Home Health Services • Home Delivered Meals • Personal Care Supports • Home Modifications • Assistive Technology • EHRS Traditional Providers: • Hospitals • Nursing Facilities • Physician (PCP/SCP) • Behavioral Health • Disease Management • Prescription Drugs • Ancillary Services • Dental • DME • Transportation

  10. Resources Alzheimers http://www.alz.org/ Agencies & Organizations Serving Seniors www.Illinois.gov/Resources/Pages/directory-main.aspx HFS LTSS home page https://www.illinois.gov/hfs/MedicalProviders/ltss/Pages/default.aspx Eldercare Locator http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx Housing Locator http://www.ilhousingsearch.org/ News and Publications http://www.illinois.gov/aging/Resources/NewsAndPublications/Pages/default.aspx Medicaid.gov https://www.medicaid.gov/state-resource-center/innovation-accelerator-program/related-tools-and-guidance/related-tools-and-guidance.html\ Centers for Independent Living incil.org 217-525-1308 v/tty Senior Helpline 1-800-252-8966

  11. Questions???

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