1. The Managed Care Difference Mission: The CareSource Heartbeat
Making a difference in the lives of underserved people by improving their health care
Vision
CareSource will be an innovative leader in the management of quality public sector health care programs

2. CareSource Model Non-profit, mission driven Member Focused
Enhanced benefits, no co-pays
CareSource 24 nurse triage service – excellent customer satisfaction
Care Management continuum – member centric care
Community based care management, marketing, and provider relations programs
Regional Consumer Councils
Provider Focused
Physician enhanced reimbursement
Low hassle approach to medical management
Health Care Home Program
Provider portal tools to promote preventative and wellness activities
Best practice administrative efficiencies
Technology investments

3. Why Managed Care? Quality NCQA, URAC and best practice compliant
Accountability to Policymakers and Taxpayers
Budget Predictability
Improved Access to Quality Health Care
Credentialing and provider collaboratives
Focus on Coordination of Care
Cost Savings

4. What Can Managed Care Do?
Challenges lead to opportunities in managing Medicaid members
Addressing socioeconomic limitations
Initiatives to improve access to quality, cost effective healthcare
Management of multiple chronic and co-morbid disease states
Integrated behavioral/physical health

5. CareSource Focus Quality provider network Integrated Care-
Mental Health, Substance Use Disorders and Physical Health
Medical Home-
Behavioral Health
Case Management Partnerships-
Access
Services-Evidenced Based Practices

6. Integrated Care
Mental Health, Substance Use Disorders and Physical Health
Improved Outcomes
Increased Efficiency
Increased Effectiveness
Increased Flexibility
Decreased Costs
Decreased Administrative Burden

7. Medical Home Behavioral Health Patient Centered
Facilitates partnerships between individual patients, personal physicians and patient’s family
Bi-directional

8. Behavioral Health Core Services
Evidenced Based Practices (EBPs)
ACT
Medication Management
Family Psychoeducation
Integrated Mental Health and Substance Use Services
Illness Self Management

9. Evidenced Based Practices
Gaps in access to these services due to the complexity and fragmentation of the current healthcare system
Administered by different systems with different rules
Subject to different funding streams
Explore expanding relationships to allow for coverage of these critical services

10. CareSource Care Management
Case and Disease Management
Clinical Care Advance
Care Management Support Services
Special Needs Plan
Medicare
Quality Improvement
Medical Management/Utilization Management
Triage/Clinical Call Center
Behavioral Health/Controlled Substance Member Management
Business Analysts

11. Behavioral Health Services
Traditional Case Management
Intensive Case Management
CARE4U Case Managemet
Bridge to Home

12. Behavioral Health Team
The BH Team consists of Case and Medical Management for members with BH needs
BH Medical Management team is comprised of:
Patient Care Coordinators (PCC) - RNs and SW
Prior Auth Specialists (PAS) - non clinical administrative support
Psychiatric Consultants
Case Management team is comprised of:
RN’s, SW and Psychiatric Consultants
Case Management includes care for Low, medium and high stratification members and a BH Intense Case Management Program 12

13. Reliance on Partnerships
State and County Government Agencies
Service Providers
Advocacy organizations