Partnering with UnitedHealthcare Community Plan of Tennessee

Agenda

• Introduction to UnitedHealthCare Rita Johnson-Mills

• Population Health Sandy Sanderson

• CHOICES Program Overview Keith Payet

• CHOICES Care Coordination John Madondo

• Person Centered Practices Courtney Kelly

• Provider Relations Deborah Stewart

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Our United Culture

Values

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Population Health

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What is Population Health?

“The Population Health Model touches members across the entire care continuum, promoting healthy behaviors and disease self-management, as well as providing care coordination and intense care management as needed and supported by evidence-based medicine and national best practices. The Contractor shall evaluate the entire enrollee population and identify enrollees for specific programs according to RISK, rather than disease specific categories”.

2015 TennCare Contractor Risk Agreement (CRA) A.2.8.1.1

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Population Health Management - Whole Person Health Models of Care

CHILDREN

Healthy Babies and Children

NICU

Children with Chronic Conditions

(Asthma,CRF)

Intellectually and/or Developmentally Disabled Children

Children with SED/SUD

Children with Genetic/Inherited

Conditions

MATERNITY CARE

Low Risk Maternity

High-Risk Maternity (Prior NICU,

Smoking, SA)

Pregnant Women with SMI/SUD

ADULTS

Well Adults

Adults with Co-Morbidities

Adults with SMI/SUD

Intellectually and/or Developmentally Disabled Adults

Adults with Genetic/Inherited

Conditions)

Adult Advanced Illness

SENIORS

Active Seniors

Seniors with Co-Morbidities

Seniors with SMI/SUD

Senior Advanced Illness

INSTITUTIONAL/ INSTITUTIONAL

ELIGIBLE

Frail at Home

Institutionalized Elderly and Disabled

Foster Children

TN LTSS CHOICES Program Overview

July 9, 2012

What is the CHOICES Program

9

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

• TennCare offers long term care services through the CHOICES program.

• Integrates long-term care services into the existing manged care delivery system

• Expands access to cost effective home and community based services (HCBS) by providing members a choice in obtaining services in the home and community, or admission to a nursing facility.

• Provides comprehensive, person-centered coordination of care for Medicaid covered services for members enrolled in the CHOICES program

• Supports the role of family and friends in the member’s life

UnitedHealthcare Community Plan and You

10

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

How do we connect with you?

Provider Services Call Center CHOICES Care Coordination Team Case Management Quality Management Behavioral Health Community Outreach Member Advocate Team and Member Services Population Health Management Caring or the “whole” member

CHOICES Care Coordination

CHOICES Care Coordination• Assessing people’s needs and goals

• Developing  person centered Plans of Care (POC)

• Aligning available resources

• Linking to the person’s community

• Appropriate facilitation of information exchange

• Proactive facilitation of consumer's transitions

• Supporting consumer’s engagement and self-management goals

• Monitoring, follow-up and responding to changes in the consumer's needs

• Behavioral Health Care Coordination

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Person Centered Practices

Person Centered Practices

• Historically, the long-term care system primarily focused on the medical condition and diagnosis of the person receiving services. The efforts directed were on “fixing” the person and their deficits, and processes were inflexible.

• We believe there is a better way. Person Centered Practices is an approach and philosophy that always puts the person first.

– Emphasis is on supporting the person’s unique needs and focuses on maximizing the person’s opportunities to live independently in the most integrated community setting they desire.

– The person leads the planning process, and the focus of the team should be on the person’s strengths, capacities, preferences, needs, and desired outcomes for their life.

• United Healthcare will look to incorporate the principles and philosophies of Person Centered Practices with our IDD members, by supporting them in directing the person centered planning process, and ensuring that the person has choice.

Provider Relations

Credentialing and Contracting Process

Provider Requirements: Must be a Medicaid provider. Must maintain appropriate licensure and an active contract with the

Department of Intellectual and Developmental Disabilities.

Once a provider’s initial application is approved, the following steps will occur:

UHCCP Provider Advocate will complete an on-site assessment. Quality Attestation must be signed by the provider. Financial viability review will be conducted by UHCCP on the provider. Provider Advocate will conduct an orientation with the provider and

staff, which will include a detail review of the CHOICES program.

If there are no deficiencies cited during the on-site assessment, UHCCP will forward an agreement for signature. If deficiencies exist, they must be satisfied before moving forward in the process.

Claims

Claims should be submitted through Office Ally Office Ally is free to all UHCCP providers. Providers may sign up for Office Ally at:

www.officeally.com Please ensure to select UB04 for claims submission.

Providers have 120 days from the date of service to submit a claim for consideration. Corrected claims must be submitted within 60 days of the denial on the explanation of benefits, max of 180 days.

Provider Advocates will train billing staff at the provider’s office

Provider Advocate Team

We will train your staff on-site on the CHOICES program.

We will train your billing staff , on-site, on claims submission.

We are your primary contact if you experience any claims issues.

We will visit your offices with proactive claims reports to review on site with your billing staff. We will submit claims for reprocessing and provide training to your staff to walk you through the process.

Please visit our booth after the presentation for a list of the Provider Advocates, with our contact information.

Question & Answer