Welcome to Home State Health

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Presentation transcript:

Welcome to Home State Health Quality Healthcare is at the Heart of What We Do

& Overview 18,000 100+ 90+ employees 100,000 members Providers WHO WE ARE in our provider networks 18,000 Providers 100+ Hospitals & OUR PURPOSE Operations in 54 counties serving over 100,000 members 90+ employees Transforming the Health of the community, one individual at a time. OUR MISSION Better health outcomes at lower costs Focus on Individuals │ Active Local Involvement │ Whole Health OUR BRAND PILLARS Our local approach provides accessible, high quality and culturally sensitive healthcare services to our members. Our integrated care coordination model can only be delivered effectively by a local staff, resulting in meaningful job creation in Missouri. offices in St. Louis & Jefferson City in Missouri 119 of 127 RHCs 20 of 23 CMCHs 14 FQHCs

Home State Results Improved Member Health Outcomes 2012-2014 (2015 Coming Soon) 18% NICU rate decrease 34% very low birth weight rate decrease 14% Emergency Room utilization decrease Improved Access for Members 170% membership growth since 2012 52% network growth since 2012 Approximately 25,000 outreach connections with members to date 2015 Prompt and Accurate Payment for Providers Claims paid in less than 7 days from receipt 97% claims paid within 15 days 92% of claims paid without manual intervention Local call center answers 90% of calls within 30 seconds, with less than a 1% abandonment rate

Innovative Programs Mobile App Technology: Members have access to mobile applications Member Portal: Interactive member tools to stay up-to-date on health needs Member Concierge: Real-time assistance with PCP appointment setting Primary Care Coordinators: Share high-risk member conditions & care gaps with PCPs Health Coaches: Health screenings, 24/7 hotline, active case management CentAccount: Expanded financial awards for healthy behavior StartSmart for Your Baby: Care management techniques designed to extend the gestational period and reduce the risks of pregnancy

Innovative Programs – Cont. Member Connections: Designed to provide education to our members on how to access healthcare and develop healthy lifestyles in a setting where the feel most comfortable MTM Transportation: Members have access to transportation for their non- emergency medical care. This includes same day transportation for PCP and OB visits.

Anticipated Managed Medicaid Expansion Timeline 4/29/16- RFP and Data Book prepared by the MO HealthNet Division will be made available by the OA Division of Purchasing for competitive solicitation. 7/1/16- Bid/proposal period closes. Materials due to the Office of Administration, Division of Purchasing. 7/1/16 through 9/30/16- Bids will be scored by an evaluation committee made up of representatives from applicable state agencies. 10/1/16- Contracts will be awarded by the Office of Administration. 10/1/16 through 4/30/17- The companies awarded the managed care contracts will develop their provider networks and begin pre-enrolling Medicaid participants. 5/1/17- Medicaid services through the statewide managed care system begin.

May 1, 2017 Regions

Web-Based Tools Through Home State website, providers can access: Provider Reference Manual Provider Billing Manual Prior Authorization List Authorization Search by Code Operational Forms HSHP Plan News Clinical Guidelines Provider newsletter Logon to www.HomeStateHealth.com and become a registered provider

Provider Secure Portal Through our secure portal, providers can: Verify eligibility and benefits View eligibility list View Care Plans View and submit authorizations Submit and check status of claims Review payment history Submit Provider Demographic Updates Secure Contact Us Benefits of the Secure Portal: No waiting No on-hold music No time limits Registration is free and easy

Questions?