Florida TD Best Practices & Training Workshop ProgramMarketing the Coordinated System to Managed Care Organizations

and Others Needing AccessAugust 10, 2011

Jo Ann Hutchinson, United We Ride Ambassador National Resource Center for Human Service Transportation Coordination

This Session Provides Information On:• History, Trends and National Changes in Medicaid and

Managed Care• How to Prepare for Changes in Florida• How to Market Your Coordinated System and Turn Change

Into an Opportunity• How to Expand Your Coordinated Services Beyond Medicaid

Transportation • How to Develop an Action Paln• Contacts for Managed Care Plans• Available Resources to Help

How We Respond to Change is Important

“When the time to perform arrives, the time to prepare is past” ….. CEO Southwest Airlines

Change is Coming to Medical Transportation in Florida

• The Florida Legislature took action to move non-emergency transportation to managed care – it’s the law

• House Bill (HB) 7107, relating to Medicaid Managed Care, was passed by the Florida Legislature on May 6, 2011. The bill outlines a comprehensive expansion of managed care for most Medicaid recipients throughout Florida.

• HB 7107 directs the Agency for Health Care Administration to apply for and implement state plan amendments and waivers of applicable federal laws and regulations necessary to implement the Statewide Medicaid Managed Care Program

• How and when you prepare is critical!

Managed Care is Not New to Transportation Nationally

• Managed care has always been a large part of Medicaid services across the country

• Today, more than 55% of Medicaid is provided through Managed Care.

• States are increasingly turning to Managed Care

What’s a State to Do?

• States have been using alternative delivery systems to provide health care through HMO’s and Managed Care.

• Intermediaries have been utilized to control health care costs.

• They are now being used to control transportation costs.

State Revenues are Decreasing Yet Medicaid Enrollees are Increasing

• States are having to do more with less• State staffing is not increasing• More persons are unemployed qualifying for

Medicaid• The 2014 Affordable Health Care Act will bring on

new members never before eligible for Medicaid

New Medicaid Population

The new Medicaid population will be mainly adults who have not had insurance and therefore have not had good preventive or chronic care.

Who Runs Medicaid – CMS or the State?

• CMS (Center for Medicare and Medicaid Services) makes basic regulations

• The State has great flexibility in designing a program to fit their population and administers the program (i.e. there are 50 State Medicaid models)

Managed Care• States are turning to Managed Care Organizations (MCO) to

manage transportation as well as the medical care.• Managed Care Organizations often utilize brokers to manage

their transportation needs • Between 2001 and 2009, the number of states using exchange

brokers rose from 29 to 38 (an increase of 31 percent).• Brokerage programs may include wheelchair vans, taxis,

stretcher cars, transit passes and Medicaid non-emergency medical transportation tickets, and other transportation methods.

• Managed Care traditionally turn toward taxi and private paratransit providers connected with ambulance service

“Better care, better health, lower cost through improvement.”

Quote from:

Donald Berwick, AdministratorCenter for Medicare and Medicaid Services

The Time to Prepare is Now!

Preparation Questions:

(1) What does the change mean to your system? (2) Who should you talk with in your area or region? (3) How do you develop a concise and positive proposal to

present to the appropriate authority?(4) How to follow-up with the appropriate authority?(5) What will you do if you lose the Medicaid service?

How To Prepare for Change?

• Educate, Educate, Educate

• Develop an action plan

• Stay focused on the goal: Maintain the coordinated system

What Does the Change Mean to Your System?

• Is Medicaid your only business? Maybe it’s time to broaden your scope of service and identify new contracting opportunities.

• What other services can you take on if you do not have Medicaid?• Are there services with hospitals, dialysis centers, American Cancer

Society, United Way and others that can be contracted?• Are there more general public and commuter riders to seek out?• Are there special event transport services you might consider?• Are you partnering with universities, colleges, public and private schools

or vocational schools for services?• Do you have a working relationship with brokers who may also be

competing for the same service?• What is the impact to other purchasers of service if Medicaid is removed

(higher rates, loss of service)Remember with the chaos of change comes great opportunity!

Get to Know the Brokerages• Identify and educate yourself on the national transportation brokers within

your state. Many national brokers are also interested in serving Medicaid enrollees so developing a business relationship with them as a provider is important.

• Identify their Network Management Department and introduce yourself to them by phone or email and be available to discuss ways you might work together.

• Known National Brokers (more may be under development): – TMS at www.tmsmanagementgroup.com – MTM at www.mtm-inc.net– LogistiCare at www.logisticare.com – AMR Access2Care at www.amr.net – MV at www.mvtransit.com – First Transit at www.firsttransit.com – Veolia Transportation at www.veoliatransportation.com – American Logistics at www.amlogo.com

Develop an Action Plan With these Elements

• Education and advocacy• Showcase your coordinated system (customer

satisfaction, costs control, safety, community support)

• Identify others to deliver your message in a united way (elected officials, business leaders, LCB Chairs and members, consumers, advocacy groups and the media)

Who Should you Talk with in your Area or Region

• There are 11 AHCA Regions• There are 25 Managed Care Plans• There are 19 Health Maintenance Organizations (HMO)• There are 6 Provider Service Networks (PSN)• There are also Exclusive Provider Organizations (EPO),

Accountable care organizations, Children's Medical Services Network and Specialty Plans (serving a specific target population based on age, chronic disease state, or medical condition of the enrollee)

Note: A handout is available listing these organizations in your area.

People to Educate and Market Your Services• Medicaid HMOs

A Health Maintenance Organization (HMO) is an entity licensed under Chapter 641, Florida Statutes. HMOs provide comprehensive Medicaid services to a defined population of Medicaid recipients; are required by contract to ensure that their enrollees have access to all Medicaid state plan services and a complete network of providers. HMO networks are not limited to Medicaid providers and some plans cover additional benefits beyond those paid for by Medicaid such as preventive adult dental.

• Provider Service Networks (PSN) is a network established or organized and operated by a health care provider or group of affiliated health care providers, including minority physician networks and emergency room diversion programs that meet the requirements of Section 409.912 (4) (d) , F.S.

• Exclusive Provider Organizations (EPO) are individual providers or groups of providers who have entered into written agreements with an insurer to provide health care services to subscribers.

• To learn more about these plans visit:

http://ahca.myflorida.com/MCHQ/Managed_Health_Care/MHMO/index.shtml

People to Educate and Market Your Services

• Others to learn about include: Accountable care organizations, Children's Medical Services Network and Specialty Plans (serving a specific target population based on age, chronic disease state, or medical condition of the enrollee)

• The current Children's Medical Services (CMS) Network is under the Department of Health, and can be accessed through this page: http://www.cms-kids.com/

• Currently there are no Accountable Care Organizations.

What’s Your Message and Who Else Can Assist? To help get the message across, consider involving the Chair of the Local Coordinating Board in the initial meeting and possibly a Medicaid rider who benefits from your coordinated service

Describe the coordinated system, its history, individuals served, quality and safety standards of your service, cost history for the services and how you canbe a partner to improve mobility for Medicaid recipients

Discuss your “unseen assets” such as excellent service, safety, low or no complaints, on-time performance, and political clout

Discuss your “seen, but not appreciated assets” such as professionally trained staff, good vehicles that are well maintained, drug and alcohol tested drivers,excellent monitoring by State DOT, State TD Commission and other State agencies who purchase your services

What’s Your Message?

Let them know what you can do for them – they also face a tough task so having a willing and able business relationship will be a win-win for everyone!

Let them know how your system can improve healthy outcomes by making surethere is reliable, accessible, safe and cost effective transportation.

Stress customer satisfaction and emphasize how fewer complaints means less administrative time and costs for them as the managed care organization

Leave with them a written document of the information provided including contact information.

Follow-up after the meeting with a thank you letter and a phone call.

Bottom Line – Relationship Building and Selling Your Excellent Coordinated Services Should Be Your Goal

Available Resources

• Training: The Competitive Edge: Making Community and Public Transit the Best Alternative for Medical Transportation (2-Day Intensive Training Session) is offered by CTAA. CUTR and the Commission are considering offering this to Florida CTCs in the near future.

• Jo Ann Hutchinson, United We Ride Ambassador is available to assist in facilitating discussions with managed care organizations and others. Contact me at hutchinson@ctaa.org or 800.891.0590, Ext. 730.

• CTAA’s Medical Transportation Specialist, Valerie Miller is available at miller@ctaa.org or 202.294.2212.

• Contact Information on Managed Care Organizations http://ahca.myflorida.com/MCHQ/Managed_Health_Care/MHMO/docs/MCAID/LIST_MEDICAID_HMOs.pdf

Ambassador Contact Information

Jo Ann Hutchinson, United We Ride Ambassador-Region 4National Resource Center for Human Service Transportation

Coordination (NRC) Toll Free: 800.891.0590, Ext. 730Email: hutchinson@ctaa.org

Website: www.nrctransportation.org Blog: www.ctaa.org/nrcregion4

Any Questions

Thank You & United We Ride!