1. Kentucky Primary Care Association
MCO Panel

2. About Anthem Medicaid
Members
Providers
Quality
Covered Services
Value Added Benefits

3. 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.

4. 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

5. 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

6. Outreach Territories
Rhonda Petr, Director of Marketing and Community Outreach |
Jennifer Barnett, Manager of Community Outreach |

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

8. 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

9. Provider Incentives
Provider Access and Quality Care Program (PAQCP) – targets PCPs with panels between 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:

10. 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

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

12. 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:
cky_PDL_English.pdf

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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!