Kentucky Primary Care Association MCO Panel

About Anthem Medicaid Members Providers Quality Covered Services Value Added Benefits

About the Outreach Team Since 2014, the Anthem Medicaid team can be found across the Commonwealth listening to members, interacting with providers and partnering with community-based organizations.

Community Involvement State-wide partnerships with thousands of organizations Support outreach efforts in every KY county Sponsor hundreds of events, initiatives and programs state-wide Health promotion activities in schools Dental Handwashing Nutrition Bullying prevention

Community Involvement Support Health Education and Research Health, Career, Safety and Resource Fairs Community Service Agencies-Fundraisers Homeless Shelters Recovery Homes Food Banks-Education and Volunteering Public Libraries-Children’s programming Public Medicaid Q&A sessions Health Departments-Councils, Coalitions, Collaborations Extension Offices-Community Baby Showers Re-Entry Councils-Addressing SDOH for Re-Entry Populations

Outreach Territories Rhonda Petr, Director of Marketing and Community Outreach Rhonda.petr@anthem.com | 502-619-6816 Jennifer Barnett, Manager of Community Outreach Jennifer.Barnett@anthem.com | 502- 269-2033

Membership – 126,292 31,652 10,731 8,292 19,073 12,027 7,617 17,285 19,615 as of 10/30/17

Provider Network Anthem Medicaid has a very comprehensive, statewide network that includes over 20,000 providers. The overall network composition is as follows: Region 1 – 1,641 Region 2 – 2,503 Region 3 – 10,275 Region 4 – 3,855 Region 5 – 7,999 Region 6 – 1,693 Region 7 – 1,903 Region 8 – 5,024 Hospitals 107 PCP’s Over 3,600 Specialists Over 14,000 BH Over 2,000

Provider Incentives Provider Access and Quality Care Program (PAQCP) – targets PCPs with panels between 250 - 999 members. Provider Quality Incentive Program (PQIP) focuses on PCPs with panels over 1,000 members Behavioral Health Quality Incentive Program (BHQIP) - targets Behavioral Health Providers (such as CMHCs, CSBs, and LMHA’s) Anthem Medicaid offers incentive programs to reward valued providers for the quality care provided to our members. Using a system of quality and access measures, and pay-for-performance principles, the programs seek to encourage efficient, preventive and cost-effective health care practices. Eligible providers who meet certain eligibility requirements and quality and access/utilization targets can receive additional incentive payments. A few of the current program options are as follows:

Utilization Management Member Rights & Responsibilities NCQA Accreditation Quality Improvement Network Management Credentialing Utilization Management Member Rights & Responsibilities Member Connections Standards: Scored 100% of the available 50 points. Survey held March 27-28, 2017

Covered Services Physician office visits No referrals required Inpatient & outpatient services Emergency services Home health Maternity services Chiropractic care Prescriptions

Pharmacy Care Immunizations are NOW covered in Pharmacy’s in lieu of members visiting PCP Drug Formulary can be found on the member website at: https://fm.formularynavigator.com/FBO/4/Kentu cky_PDL_English.pdf

Enhanced Vision Services Eyeglasses for Adults OR a credit for contacts ANNUALLY Eyeglasses for children (up to two pair per year with EPSDT benefit) Special needs eyeglasses for children (when medically necessary) Vision screenings for all ages EyeQuest is our vision vendor

Enhanced Dental Services Reimbursement codes for missed appointments Nitrous oxide for children when medically necessary Services on multiple quadrants during one visit Scaling and root-planing DentaQuest is our vendor

Value Added Benefits No Copays (for anything…) Free Eyeglasses for ADULTS annually OR a credit towards contact lenses (Anthem is only MCO that offers that!) Free sports physicals for kids Free OTC medicines (with prescription) Free crib or car seat for expectant mothers (attending 7 prenatal visits) Free reloadable gift cards for prenatal rewards and well child visits Free Smartphone with data, minutes AND unlimited texting

Success Story - Anna Member “Anna” recently switched to Anthem Medicaid. She had been: Been experiencing multiple health issues including uncontrolled diabetes and renal failure In and out of nursing and personal care facilities, had no independence Having trouble filling prescriptions Missing appointments because of transportation issues Experiencing multiple ER visits and hospital admissions due to her uncontrolled health issues Living with a friend and the situation was causing additional anxiety and depression She was overwhelmed, inundated with issues and to make matter worse… She did not have a reliable way to communicate with her health team

Success Story - Anna Anthem’s Case Managers worked with Anna over several months and assisted her by: Placing her on formulary insulin prescription Helping her obtain a glucose meter and supplies Case Managers helped to work through a DCBS system-issue to remove an old primary insurance listing which was preventing her prescriptions from being properly filled She was able to select a new, local PCP and dialysis center She obtained a new smartphone to communicate with her physician and MCO Eventually moved in with her aunt for a more stable & healthy environment

Success Story - Anna Anna is now living with her aunt, is in control of her health conditions, is attending behavior therapy and working closely with her social worker and case manager. She is keeping all of her doctor’s appointments, and has not had an ER visit or hospital admission in eight months! She reports that she is now healthier, happier, and more independent!