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The Managed Care Difference Mission: The CareSource Heartbeat

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Presentation on theme: "The Managed Care Difference Mission: The CareSource Heartbeat"— Presentation transcript:

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


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