Presentation on theme: "Ms. Bz Giese, BSN, RN Director, Office of Health Initiatives South Carolina’s 17 th Annual Rural Health Conference South Carolina Department of Health."— Presentation transcript:
Ms. Bz Giese, BSN, RN Director, Office of Health Initiatives South Carolina’s 17 th Annual Rural Health Conference South Carolina Department of Health and Human Services Health Access at the Right Time (HeART)
Eligibility Current enrollment as of August 31, 2013 : Children 18 and under: 591,105 Adults age 19-64: 326,901 Adults 65+: 77,277 _____________________ Total: 995,283
South Carolina Medicaid expenditures have grown 38.21% from FY2007 to FY2014. This is a 4.8% annual growth. SFY 2014 spending would be $1.2 billion (64%) higher without agency actions to control costs and improve outcomes since 2011. This would have been a 7.3% annual growth. SC Medicaid Total Expenditures
SC Medicaid: Expenditures by Eligibility Category
Current Budget to Year to Date Example’s only – not inclusive of entire budget As of July 31, 2013 * Example s only – not inclusive of entire budget As of July 1, 2013 FY2014 Appropriation FY2014 YTD Remaining % Expanded Coordinated Care $2,156,884,310$137,699,779$2,019,184,5316% Hospital Services 717,588,84064,414,127653,174,7139% Disproportionate Share 480,128,621128,782,115351,346,50627% Pharmaceutical Services 207,504,80313,277,063194,227,7406% Physician Services 215,045,91311,622,396203,423,5175% Lab and X-Ray 27,606,0071,839,70225,766,3057% DDSN 562,521,32859,053,528503,467,80010% DMH 154,400,0007,205,535147,194,4655% TOTAL SCDHHS Budget 6,482,544,497549,137,5875,933,406,9108%
To identify alternative methods and providers for health care delivery access at the right time and the right place Components of HeART include: Retail Clinics Hybrid Clinics Telemedicine After Hours Codes School Based Health Clinic Sustainability Model Community Health Workers (CHW)
CCCs provide episodic care for all Medicaid recipients 18 months and older Coverage of EPSTD well-visits are not included for children under the age of 5 SCDHHS monitoring claims; earache and sore throat Goals: To reduce health care costs by avoiding unnecessary emergency room visits To provide a service site with extended hours for patients when primary care physician offices are closed To assist in supporting efforts in chronic disease management Convenient Care Clinics
All 28 CVS MinuteClinic locations in SC & 89 CVS MinuteClinic Nurse Practitioners are enrolled as Medicaid providers with 5 additional sites being established this year All MCOs have contracted with CVS MinuteClinic (BlueChoice, Absolute Total Care, Select Health and United/WellCare) SCDHHS/IFS is routinely monitoring claims data to assess the impact of services on health outcomes Walgreens Take Care clinics expect to enter the SC market in 2014 Convenient Care Clinics, cont.
Model will give Free clinics opportunities to: - Maintain volunteer staff and utilize paid providers - Provide quality medical care to patients with low income (uninsured and Medicaid beneficiaries) - Charge fees on a sliding scale allowing free care to very low income patients SCDHHS visited /interviewed 34 out of 37 Executive Directors statewide Currently 5 free clinics are interested in transitioning into a hybrid model Hybrid Clinics
Effective on April 1, 2013, Primary Care providers were able to start billing for 2 after office hour codes, to help reduce the need for Medicaid beneficiaries to seek services in the emergency room Reimburses additional $12 per visit Authorized Primary Care providers are Pediatricians, Family Practice, General Practice, Internal Medicine, and Obstetrics and Gynecology After Hours Codes
After Hours CPT codes include: 99050 – Service(s) provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (i.e., holidays, Saturday or Sunday), in addition to basic service 99051 - Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service After Hours Codes, cont.
Address provider shortage areas Connects urban specialty care with rural patients May increase cost efficiency Lessens transportation concerns Strengthens communication among providers Examples of Services Include: Consultation – Inpatient & Outpatient Pharmacologic Management Neurobehavioral Status Exam E&M Office Visits Telemedicine
Proviso 33.34 Section E(2) and Telemedicine “The department shall develop a program to leverage the use of teaching hospitals to provide rural physician coverage, expand the use of Telemedicine, and ensure targeted placement and support of OB/GYN services in at least four (4) counties with a demonstrated lack of adequate OB/GYN resources by July 1, 2014.”
Selected four target counties based on IFS Data: Bamberg, Barnwell, Allendale and Hampton Working with MUSC and USC to incorporate specialty MFM care for patients that are identified as high-risk through use of Telemedicine equipment Will utilize Telemedicine to greatly enhance the OB/GYN services available in these rural and underserved counties Proviso 33.34 Section E(2) and Telemedicine
Goals 1. Create a sustainable model for Charleston Promise Neighborhood’s (CPN) school based clinics; lessens need for grant money 2.Utilize this model as a foundation to support SBHC’s in other schools, and helps provide another access point for medical care CPN Participating schools have an on-site health clinic staffed by a Nurse Practitioner : - James Simons Elementary School - Chicora School of Communications - Mary Ford Elementary School - Sanders-Clyde Creative Arts School (middle) School Based Health Center Sustainability Model: CPN as Case Study
In addition SCDHHS will: Help facilitate using a shared eligibility worker for the CPN school district Partner to host health fairs that will include Medicaid enrollment and parents/community engagement in fall of 2013 Model supports PCMH concept by ensuring the student’s PCP receives school/NP report of each visit School Based Health Center Sustainability Model: CPN as Case Study, cont.
CHW Goals 1.Improve patient care and health outcomes through compliance in health screenings, maintaining office appointments, adherence to medication therapy and management of chronic diseases 2. Certification through core curriculum training program helps provide culturally and linguistically appropriate support, guidance, encouragement and compliance with follow up care Accomplishments Phase I: 18 certified CHWs placed in 14 primary care practice sites (including two FQHCs) across the state CPT codes for CHW services billed by MD or NP S9445 Individual Code S9446Group Code Phase II: Introduce different care delivery models as participants in the CHW program CHW Goals 1.Improve patient care and health outcomes through compliance in health screenings, maintaining office appointments, adherence to medication therapy and management of chronic diseases 2. Certification through core curriculum training program helps provide culturally and linguistically appropriate support, guidance, encouragement and compliance with follow up care