1. Foster Care Managed Care Program
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January 2012

2. 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
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3. 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
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4. 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
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5. 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
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6. 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
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7. 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
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8. 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
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9. 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
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