Foster Care Managed Care Program E M B R A C I N G E V E R Y C H I L D 1 January 2012

Texas Foster Care Program Goals Texas Foster Care Program Goals support CFSR Safety, Permanency and Well-being Outcome Measures Improve access to care by establishing an integrated medical home Improve coordination of services Improve functional outcomes and overall stability of children and youth in foster care through enhanced quality of services Foster Care Managed Care Program E M B R A C I N G E V E R Y C H I L D 1 2

Texas Foster Care Program Structure Texas Health and Human Services Commission Contracting Entity State Medicaid Agency Oversight by State Medicaid Director and Managed Care Operations Department of Family and Protective Services deliverables by contract Contract specific to the provision of all health care services Statewide, full risk, single managed care organization program Procurement process Single point of accountability for the State “Voluntary” nature allowed for no CMS waiver or plan amendment Includes all health services – behavioral, physical, dental & vision Pharmacy benefits will be added March 2012 Foster Care Managed Care Program E M B R A C I N G E V E R Y C H I L D 1 3

Consistent State Foster System Challenges Fragmented service delivery system Access to service issues No continuity, coordination or management of services Significant duplication of services Eligibility verification issues Psychotropic medication utilization Poor communication or linkage between stakeholders Lacking functional or health outcome measures Need support and education for foster caregivers, providers and stakeholders Foster Care Managed Care Program E M B R A C I N G E V E R Y C H I L D 1 4

Service Delivery Solutions and Results Improved Access to and Continuity of Health Care Services Immediate Eligibility Daily notification of children in custody Provider Network Management Continual recruitment and network adequacy monitoring Less than 20% utilization with Out of Network providers & facilities PCP assigned within 24 hours Well Child visits improved from 42% to70% within 90 days Creation of Trauma Informed Specialty Provider Network Over 130 mid-level providers included INTENSIVE Service Integration Behavioral, Physical Health, Dental and Vision Services Integrated Service Management and discharge planning processes and tools Significant co-location and cross training of resources Joint quality programs, committee structure and medical policy Foster Care Managed Care Program E M B R A C I N G E V E R Y C H I L D 1 5

Service Delivery Solutions and Results Improved Access to and Continuity of Health Care Services Robust Service Management/Coordination model 100% of membership assessed for Service Management needs Use of Impact Pro predictive modeling tool to identify and validate 6,243 Active participants in Service Management Reduction in acute care inpatient readmission rate from 9.3% to 7.4% Reduction in psychiatric inpatient length of stay from 11.5 to 10 days Complex case management = 44% decrease in psychiatric admissions Functional Outcome Measurement for Children in Service Management Utilizing Ohio Youth Scales 58% of children show improved functioning 59% of children show a decrease in problem severity Foster Care Managed Care Program E M B R A C I N G E V E R Y C H I L D 1 6

Service Delivery Solutions and Results Improved Access to and Continuity of Health Care Services Psychotropic Medication Utilization Review 17% Reduction in Psychotropic Medication use Class Polypharmacy decrease of 28% 5 or more medication use decrease of 36% Foster Care Managed Care Program E M B R A C I N G E V E R Y C H I L D 1 6

Service Delivery Solutions and Results Improved Communication and Linkages Education support Over 390 trainings conducted in 2011 for providers, caregivers and stakeholders Health plan staff integrated into state department regional operations for support Regionally located behavioral health clinical trainers 24/7/365 Customer Support, Nurse Hotline and Behavioral Health Crisis Line Health Passport – Electronic Community Health Record Foster Care Managed Care Program E M B R A C I N G E V E R Y C H I L D 1 8

Health Passport Foster Care Managed Care Program Goal of the tool: To improve member health, visibility, communication and coordination between providers, caregivers, caseworkers and service management teams Web based community health record Populated with at least 2 years of prior claims and pharmacy history Multiple state and vendor interfaces feed Passport daily Provider adoption data: Physical and Behavioral Health providers entered over 75,000 forms online Average number of unique user log-ons per month over 6,000 End-user surveys returned 89% satisfaction rate of the tool Foster Care Managed Care Program E M B R A C I N G E V E R Y C H I L D 1 9