Indiana Care Select Overview

1
Indiana Care Select Overview
Mitchell E. Daniels, Jr., Governor State of
Indiana Indiana Family and Social Services
Administration Anne W. Murphy, Secretary Pat
Casanova, Medicaid Director
2
Todays Agenda

• Program Goals Overview
• Member Enrollment Process
• Primary Medical Provider (PMP) Overview
• Certification Code Policy
• Right Choices Program Referral Process
• Care Management Overview
• Member Support Services
• Care Coordination Conferences
• HEDIS
• On-line CM Portals
• Question Answer

3
Program Goals

• To more effectively tailor benefits to its
  members
• To improve the quality of care and health
  outcomes of its members
• To control the growth of health care costs
• To provide a more holistic approach to members
  health needs

4
Program Overview

• Care Coordination
• Individualize services for its members
• Assist its members in gaining access to needed
  medical, social, educational and other services
• Disease Management
• Population-based
• Target specific diseases
• Utilization Management
• Appropriate use of facilities, services
  and pharmacy

5
Program Overview

• Care Select Care Management Organizations (CMOs)
• ADVANTAGE Health Solutions, Inc.sm
• MDwise, Inc.
• Care Select Members
• Members that are Aged, Blind or Disabled
• Wards of the Court and Foster Children
• Home Community-Based Waiver participants
• Members who receive Adoption Assistance
• M.E.D. Works participants
• Will NOT include members in institutional
  settings, spend down, or dual-eligibles
  (Medicare/Medicaid)

6
Care Select Member Enrollment Process
Member letter sent
Does Member have a PMP?
Member enrolled in PMPs CMO
Member auto-assigned to CMO and PMP
Yes
Yes
No
No
Did member choose a PMP and CMO?
Enrollment Broker (MAXIMUS) begins to call
members to answer questions and help enroll
If Primary Medical Provider (PMP) is in both
plans, member will choose a plan or be
auto-assigned to a plan.
7
The Primary Medical Provider (PMP)

• What is a PMP and why is having one so important?
• Linked to each Care Select member as the members
  medical home
• Connects primary and specialty health care
• Provides referrals to specialists via telephone
  or in writing
• Works with member and care manager to improve the
  health of the member
• Who can be a PMP?
• Primary care physicians
• i.e. family practice, general practice,
  internist, pediatrician, and OB/GYN
• Specialists

8
The Primary Medical Provider (PMP)

• How does a PMP enroll?
• PMPs in Care Select may contract with one or both
  CMOs.
• Why are there two CMOs?
• IHCP wants to give both members and providers a
  choice.
• How does this affect a members choice between
  CMOs?
• The member is enrolled in the CMO with which his
  or her PMP is contracted.
• Members with no prior PMP linkage will receive a
  letter and call from the enrollment broker to
  assist in choosing a PMP.
• Members can change PMPs by contacting their CMO
  or Maximus.
• Those who do not choose a PMP get auto-assigned
  to one.

9
Certification Code Policy

• The Care Select PMP is responsible for providing
  and/or overseeing a members care during the time
  the member is linked to that PMP through the PMP
  assignment process.
• The PMP agrees to provide the necessary primary
  and preventive health services directly to their
  assigned members or agrees to refer the member to
  another health care provider for those services
  undeliverable by the PMP.
• Each Care Select PMP is assigned a cert code on a
  quarterly basis. This code, in addition to the
  PMPs National Provider Identifier (NPI) is
  needed to allow a specialist or another
  providers claims to be paid when appropriate

10
Certification Code Policy

• Policy Description Statement
• While it is always preferable that the assigned
  PMP authorize treatment and provide their NPI and
  cert code, there may be occasions when this is
  not possible.
• Appropriate and designated CMO staff will need to
  provide this information to another health care
  provider in order to allow the Care Select member
  access to appropriate and timely care
• The following are specific circumstances in which
  designated CMO staff may release to another
  health care provider a members PMPs cert code
  and NPI before or after a service has been
  rendered as approved by the State

11
Certification Code Policy

• Exceptions
• PMP change is still pending after a previously
  auto-assigned member has selected a new PMP
• Death of PMP
• PMP moves out of the region without proper
  notification to the program
• Newly transitioned members into the program (i.e.
  wards and foster children) who are in need of
  treatment (i.e. EPSDT) within the first sixty
  (60) days of enrollment
• Auto-assigned member lives in an underserved area
  and is unable to select a PMP from that area
• Other urgent, emergent, or ongoing issues (i.e.
  dialysis or emergent ER admission) where the
  member is unable to access necessary services and
  the assigned PMP is unwilling or unable to
  provide services or the appropriate referral

12
Right Choices Referral Processformerly known as
Restricted Card Program

• ADVANTAGE Health Solutions identifies and
  monitors individuals in both ADVANTAGE Care
  Select and the Traditional or fee-for-service
  Medicaid Program
• MDwise Care Select identifies and monitors
  individuals in the MDwise Care Select Program
• This includes members who have shown a pattern of
  potential mis - utilization or over - utilization
  of services
• The RCP is
• Not a loss of benefits
• Not a reduction in benefits
• Not punitive action, but is a legal action
• Note Members are still eligible for all
  medically necessary IHCP services. However, those
  services must be ordered or authorized in writing
  by the members assigned PMP

13
Right Choices Referral Process

• The RCP identifies members appropriate for
  assignment and subsequent lock-in to
• one Primary Care Physician (PCP)
• one pharmacy and
• one hospital
• The RCP Program applies to both members in
  Traditional Medicaid and Indiana Care Select
• Specialty providers receive written authorization
  from the PMP
• The CMOs add those specialists to the members
  provider list in order for the specialty provider
  to be reimbursed

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Right Choices Referral Process

• The PMP manages the members care and determines
  whether a member requires evaluation or treatment
  by a specialty provider
• Referrals are required by the PMP for most
  specialty medical providers (except self referral
  services)
• Referrals should be based on medical necessity
  and not solely on the desire of the member to see
  a specialist
• Emergency services for life threatening or life
  altering conditions are available at any
  hospital, but non-emergency services require a
  referral from the PMP

15
Right Choices Referral Process

• Adding Providers to a Right Choices Members Lock
  In List
• Additional providers may be locked-in, either
  short-term or on an ongoing basis, if the PMP
  sends a written referral.
• Providers may be locked-in for one specified date
  of service or for any defined duration of time,
  up to one year.

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Right Choices Referral Process

• When a Referral is Not Necessary Self Referral
• Behavioral health (except prescriptions)
• Chiropractic services
• Dental services (except prescriptions)
• Diabetes self-management services
• Family planning services
• HIV/AIDS targeted case management

• Home health care
• Hospice
• Podiatric services (except prescriptions)
• Transportation
• Vision care (except surgery)
• Waiver services

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Right Choices Referral Process

• Referral Guidelines for the PMP
• Referrals must be faxed or mailed
• Referrals may be handwritten on letterhead or a
  prescription pad, however, they must include the
  following information
• IHCP members name
• IHCP members RID
• First and last name and specialty of the
  physician to whom the member is being referred
• Primary lock-in physicians signature (not that
  of a staff member)
• Date and duration of referral

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Right Choices Referral Process CMO Right
Choices Contact Information

• ADVANTAGE
• ADVANTAGE Health Solutions Traditional FFS
• Attn Right Choices Program
• P.O. Box 40789
• Indianapolis, IN 46240
• 1-800-784-3981
• Fax [phone]
• ADVANTAGE Health Solutions - Care Select
• Attn Right Choices Program
• P.O. Box 40789
• Indianapolis, IN 46240
• 1-800-784-3981
• Fax [phone]

• MDwise
• MDwise Care Select
• Attn Care Management
• P.O. Box 44214
• Indianapolis, Indiana 46244-0214
• Phone [phone] or
• 317-829-8189 Option 1
• Fax [phone] or
• 317-822-7517

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Care Management Overview

• PHILOSOPHY
• Member-centered care management focus
• Strong partnerships with community providers to
  coordinate behavioral, developmental and medical
  services
• Utilize assessments and risk stratification tools
  to determine needs at the member/provider level
• Excel in communication with members, their
  families and their caregivers

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Care Management Overview
21
Step 1 Assess Member Needs

• Identify high risk members through medical claims
  history/risk stratification
• Identify and reach out to members family or
  facility case manager
• Share existing assessments/care plans to avoid
  duplicative assessment questions or interventions
• Conduct initial interview with member or
  caregiver
• Assign care management Level 1-4
• Identify the need for more comprehensive medical,
  behavioral, psychosocial, and/or functional
  assessments
• Identify immediate needs and implement immediate
  interventions if needed
• Members are reassessed and care plans updated as
  needed (at least annually)

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Stratification

• Once the assessments are complete, the member is
  stratified into one of four need groups
• Level one minimum provided to all Care Select
  members
• Level two all level one services plus more
  support/guidance
• Level three all level one and two services plus
  high level support as determined by risk issues
  related to health
• Level four all level one, two and three
  services plus support related to require most
  services and often face crisis situations
• Note all Care Select members who are pregnant or
  are seriously mentally ill are automatically
  placed into Level two and members can be
  re-stratified at anytime depending on condition
  and need

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Step 2 Design Care Plan

• Involve member, caregivers and providers in
  developing the members Care Select Care Plan
• Establishing care plan goals that are
  evidence-based and outcome-oriented
• Taking responsibility for achieving care plan
  goals
• Integrate goals/interventions across a members
• other care plans
• Primary Care
• Family Teaming
• Medicaid waiver program
• Individualized Education Plan (IEP)
• CMHC/behavioral health treatment plan
• Prioritize goals/interventions recognizing the
  members priorities

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Step 3 Coordinate Care

• Share individualized care plan with
• Member/Caregiver
• PMP
• Waiver/CMHC Case Managers
• Involve members, caregivers, Care Managers,
• Care Partners, Care Advocates, Family Case
  Managers, and providers in active dialogue about
  barriers, goals and progress
• Web-based care plans
• Care conferences
• Ongoing dialogue
• Facilitate communication with health care
  providers, i.e. physicians, community
  organizations, waiver programs, school-based
  services, and the Division of Child Services

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Step 3 Coordinate Care (cont.)

• Connect member/caregiver with needed services
• Advocate for member by
• Removing barriers to care
• Providing education about conditions, access to
  care, member rights and responsibilities
• Facilitate member/caregiver independence through
  teaching and reinforcing self-management skills
• Utilize the members comprehensive assessment and
  care plan to provide context and support for PA
  requests

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Step 4 Measure Results

• Member level outcomes
• Achievement of care plan goals
• Annual health needs assessment
• Program level outcomes
• Member and provider satisfaction
• Evidence-based practice
• Improvement in quality of life metrics
• Reduction in inpatient/ER admissions
• Complaints, grievances/appeals

27
Member Support Services

• The CMO care management teams are engaged in the
  provider community in order to create a well
  rounded approach to providing member support,
  care plan development and improved treatment
  outcomes. The CMOs currently partner with several
  providers to achieve these goals
• Community Mental Health Centers (CMHCs)
  incorporate behavioral health treatment plans
  into the members overall plan or care AND assist
  the CMHC in accessing physical health services
  (i.e. primary care and dental services) for their
  Care Select population
• Developmentally Disabled (DD) Waiver Providers
  incorporate the members plan of care developed
  by the Waiver case manager as well as non DD
  Waiver provider training materials to educate
  PMPs on best practices for working with the DD
  population AND assist the DD Waiver provider in
  accessing physical health services (i.e. primary
  care, dental, and behavioral) for their Care
  Select population

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Member Support Services

• Hospitals obtaining notification from hospitals
  that they are about to discharge a Care Select
  member allows the care manager to work to ensure
  the member has access to needed post inpatient
  services that reduce the chance of another
  inpatient admit
• Dental informing our members on the importance
  of getting dental care and reminding those, by
  mail, if they have not seen the dentist within
  the calendar year
• Social Services supporting members with social
  crisis (i.e. eviction, utilities disconnection)
  and connecting pregnant members with pregnancy
  related services (i.e. WIC, parenting classes,
  etc..)

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Care Coordination Conferences

• The CMOs will coordinate with its Care Select
  PMPs to perform care coordination conferences to
  review a members plan of care and the progress
  with that plan of care.
• Care Coordination Conference
• is a covered benefit for Indiana Care Select
  Program members assigned PMP
• can occur up to twice per member per rolling
  calendar year
• will be scheduled on a semi annual basis
• can be held in person at the PMPs office or via
  phone conference
• is a billable service (not applicable to FQHC/RHC
  providers)

30
Care Coordination Conference

• Care Coordination Conference Purpose
• open communication and coordination between all
  healthcare providers
• to provide a forum for PMPs to interact directly
  with our care management teams
• discuss the care plans of your patients and
  collaboratively decide how we can effectively
  facilitate the management of your patients
• We realize that our members often require
  complex medical care from a variety of sources,
  which often extend beyond the confines of your
  office. Our goal in care management is to
  coordinate the efforts of the healthcare team
  with other participating government, social and
  community agencies working together on behalf of
  the patient. Indiana Care Select Program CMO
  Care Management Departments

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Care Coordination Conference

• How to Schedule/Plan for the Care Coordination
  Conference
• ADVANTAGE Care Select Program
• Will notify each contracted PMP by mail, when it
  is time to schedule the conference
• Mailing will include How to schedule and
  complete your Biannual Case Conference form
  where the PMP will
• Select date and time
• Review a panel listing of your members
• Identify additional concerns
• Note any additional information
• Fax, Email, or direct mail the panel back to
  ADVANTAGE prior to scheduled date of conference
• each conference will last no longer than 60
  minutes and can be conducted via phone or an on
  site visit by request (pending availability)

32
Care Coordination Conference

• How to Schedule/Plan for the Care Coordination
  Conference
• MDwise Care Select Program
• Will notify each MDwise PMP by mail or phone,
  when it is time to schedule the conference
• Mailing will include a member checklist form and
  members care plan where the PMP will (Please
  note Providers can sign up for CareConnect and
  access each members plan of care there rather
  than receiving a mailed care plan)
• Review the members care plan
• Identify additional concerns on the checklist
• Note any additional information on the checklist
• Fax, Email, or direct mail the member checklist
  form back to MDwise prior to scheduled date of
  conference
• Each conference will last no longer than 60
  minutes and can be conducted via phone or an on
  site visit by request (pending availability)

33
Care Coordination Conference

• How to Bill for Care Coordination Conferences
• PMPs, or their designated nurse practitioner (NP)
  or physician assistant (PA) who works for the PMP
  or PMPs employer such as a group or clinic are
  eligible to receive reimbursement from Indiana
  Health Coverage Programs (IHCP) for their
  participation in the care coordination
  conferences
• Both the CMO and the PMP will be responsible for
  checking eligibility on the date of the care
  coordination conference
• Submit claims for members discussed during the
  care coordination conferences to EDS as with all
  other covered Care Select services

34
Care Coordination Conference

• How to Bill for Care Coordination Conferences
  (continued)
• No prior authorization is required for care
  coordination conferences
• Care coordination conferences are carved out of
  the Third Party Liability requirements for Care
  Select so providers do not need to submit claims
  for these services to the members private
  insurance company prior to submitting them to EDS
  for reimbursement
• Submit claims on a CMS 1500 claim form using
  the CMS 1500 paper claim format found in
  Chapter 8, Section 4 of the IHCP Provider Manual.
  Providers may also submit these claims
  electronically using their proprietary software
  or using EDSs web interChange

35
Care Coordination Conference

• How to Bill for Care Coordination Conferences
  (continued)
• The primary diagnosis providers should use when
  billing for care coordination conferences is
  either the members last known diagnosis related
  to the members disease state or V70.9
• All PMPs, or NPs must be linked to the billing
  group
• The CMO and provider will identify via the CMOs
  bi-annual Care Coordination Conference Checklist,
  potential members to be reviewed and discussed
  during the conference. If neither the PMP nor the
  CMO have issues resulting in a discussion of the
  members plan of care, the provider cannot bill
  for a care coordination conference for that member

36
Care Coordination Conference

• How to Bill for Care Coordination Conferences
  (continued)
• The Bi-annual Care Conferences Checklist verifies
  the PMPs review regarding the plan of care.
  Providers are required to keep a copy of the
  Bi-annual Care Conferences Checklist for auditing
  and documentation purposes
• PMPs are limited to billing up to two care
  coordination conferences per member per rolling
  calendar year
• The service code to be used to identify billing
  for care coordination conferences for each Care
  Select member is 99211 SC Office or other
  outpatient visit for the evaluation and
  management of an established patient. Note
  Please refer to both IHCP Bulletins BT200723
  BT200804 for further details

37
Care Coordination Conference

• How to Bill for Care Coordination Conferences
  (cont.)
• If the PMPs NP is in the same group or clinic as
  the PMP who performs the care coordination
  conference with the members CMO care manager,
  the NPs IHCP provider number is appended to
  99211 SC. If the NP is not enrolled in the IHCP,
  providers must append modifier SA
• Services for NPs not linked to the PMPs clinic
  or group will be denied because that practitioner
  does not participate in the same group or clinic
  as the members PMP and it will be assumed that
  those practitioners have no practical experience
  with that member and are not in a position to
  discuss that members plan of care

38
Care Coordination Conference

• How to Bill for Care Coordination Conferences
  (cont.)
• PAs cannot enroll in the IHCP, but can
  participate in the care coordination conference
  and be reimbursed. The care coordination service
  code 99211 SC must be billed along modifier HN or
  HO (use the modifier that corresponds to the PAs
  education level)
• The PMP or the PMPs NP or PA will be reimbursed
  by the IHCP at a rate of 40 per member per
  conference. PMPs, or their NP/PA who refuse to
  participate or do not attend a scheduled care
  coordination conference cannot bill the IHCP for
  that conference

39
Healthcare Effectiveness Data and Information Set
(HEDIS)

• The Healthcare Effectiveness Data and Information
  Set (HEDIS) is a widely used set of performance
  measures in the managed care industry, developed
  and maintained by the National Committee for
  Quality Assurance (NCQA).
• Set of standardized performance measures based on
  evidenced-based best practice
• HEDIS was designed to allow consumers to compare
  health plan performance to other plans and to
  national or regional benchmarks.
• The Indiana Care Select CMOs both use HEDIS or
  HEDIS-like measures to assess the quality
  outcomes for Indiana Care Select members.

40
HEDIS Performance Metrics

• Acute Inpatient Mental Illness 7 Day Follow-up
  (ages 6)
• Planned Activity
• Increasing the Rate of Follow-Up after
  Hospitalization for Mental Illness
• Scope and Population
• Members 6 years of age and older as of the date
  of discharge.
• Discharged alive from an acute inpatient setting
  with a principal mental health diagnosis.
• Eligible population is based on discharges (not
  members).
• Includes all discharges for members who have more
  than one discharge on or between Jan 1 and Dec 31
  of measurement year.

41
HEDIS Performance Metrics

• Acute Inpatient Mental Illness 7 Day Follow-up
  (ages 6)
• RATIONALE
• Over 40 of our Indiana Care Select members have
  a Behavioral Health Diagnosis. Selecting this
  particular HEDIS measure allows us to improve the
  health and continuity of care for a large portion
  of our population.
• Monitoring and positively affecting this HEDIS
  measurement allows us the opportunity to
  potentially decrease high cost services by
  replacing them with community interventions.

42
HEDIS Performance Metrics

• Care Select Initiatives to Increase the Rate of
  Follow-Up after Hospitalization for Mental
  Illness
• Our Care Management staff has been trained and
  has implemented new daily communication program
  between the Prior Authorization department and
  the Care Management Department to identify
  members who fit criteria.
• Coordinating with providers and members to ensure
  that follow up care is being provided in a timely
  fashion.
• Working in collaboration with the Office of
  Medicaid Policy and Planning and all of the
  Indiana Health Coverage Programs to increase the
  performance for this HEDIS metric.

43
HEDIS Performance Metrics

• Adolescent Well-Care Visit (ages 12-21)
• Planned Activity
• Increasing the Rate of Adolescent Well-Care
  Visits
• Scope and Population
• Members 12-21 who had at least one comprehensive
  well-care visit with a PMP or OB/GYN practitioner
  during the measurement year and have been
  continuously enrolled with no more than a 45 day
  gap in coverage.

44
HEDIS Performance Metrics

• Adolescent Well-Care Visit (ages 12-21)
• Rationale
• The Indiana Care Select Program has received a
  large influx of members in this age group due to
  assignment of Ward and Foster children.
• Establish a medical home-trust, coordination of
  care, outreach
• Evaluate physical health, emotional health,
  growth and development
• Allow for early diagnosis and treatment of
  chronic conditions, diseases
• Identify and provide guidance about risky
  behaviors

45
HEDIS Performance Metrics

• Care Select Initiatives to Increase Rate of
• Adolescent Well Child Exams
• Member Incentive to schedule and complete their
  Well Child exam
• Provider Incentive to ensure all assigned members
  are receiving their Well Child exam
• Initiative to increase transportation access to
  ensure all members are able to get their
  appointments

46
HEDIS Performance Metrics

• Breast Cancer Screening (ages 40-69)
• Planned Activity
• Increase rate of Breast Cancer Screenings
• Scope and Population
• Women ages 40 69 years of age who have had a
  mammogram to screen for breast cancer and
  continuously enrolled with no more than a 45 day
  gap in coverage

47
HEDIS Performance Metrics

• Breast Cancer Screening (ages 52-69)
• Rationale
• Early diagnosis of breast cancer allows for less
  invasive treatment and is associated with better
  outcomes.
• Breast Cancer Screenings have shown to reduce
  breast cancer mortality rates.
• One in 8 women in the US will be diagnosed with
  breast cancer in their lifetime.
• In an effort to improve the overall health of our
  Indiana Care Select members, we will target this
  preventative care measure to improve timely
  intervention in order to enhance treatment
  options.

48
HEDIS Performance Metrics

• Care Select Initiatives to Increase rate of
  Breast Cancer Screenings
• Member Incentive to schedule and complete their
  Breast Cancer Screening
• Provider Incentive to ensure their assigned
  members are completing their Breast Cancer
  Screenings
• Educational mailings on the importance of womens
  preventative health
• Just-in-time education and assistance with
  appointments (during health screening and
  assessment, mailings, inbound calls for other
  reasons).

49
HEDIS Performance Metrics

• Cervical Cancer Screening (ages 21-64)
• Planned Activity
• Increase rate of Cervical Cancer Screenings
• Scope and Population
• Women ages 21-64 continuously enrolled with no
  more than a 45 day gap in coverage who received
  one or more Pap tests to screen for cervical
  cancer.

50
HEDIS Performance Metrics

• Cervical Cancer Screening (ages 21-64)
• Rationale
• Early diagnosis of cervical cancer allows for
  highly effective treatment and cure.
• Easiest form of female cancer to prevent with
  regular screening tests and follow-up
• Control Studies have found that the risk of
  developing invasive cervical cancer is three to
  ten times greater in women who have not been
  screened
• Screenings can detect early changes in the body
  that may lead to cervical cancer

51
HEDIS Performance Metrics

• Care Select Initiatives to Increase rate of
  Cervical Cancer Screenings
• Member Incentive to schedule and complete their
  Cervical Cancer Screening
• Provider Incentive to ensure their assigned
  members are completing their Cervical Cancer
  Screenings
• Educational mailings on the importance of womens
  preventative health
• Just-in-time education and assistance with
  appointments (during health screening and
  assessment, mailings, inbound calls for other
  reasons).

52
HEDIS Performance Metrics

• Comprehensive Diabetes Care, Hemoglobin A1c
  (HBA1c) test (ages 18-75) LDL-C Screening (ages
  18-75)
• Planned Activity
• Increasing the Rate of HBA1c Testing LDL-C
  Screening for Diabetics
• Scope and Population
• Members 18-75 with diabetes (type 1 and type 2)
  who had an HbA1C test.
• Members 18-75 with diabetes (type 1 and type 2)
  who had an LDL-C Screening.

53
HEDIS Performance Metrics

• Rationale
• Hemaglobin A1C
• Hemoglobin A1C is a measure of blood sugar
  control over time
• Management of blood sugar levels is key to
  preventing short and long term complications from
  diabetes
• LDL-C
• Management of cholesterol levels is a major
  component for preventing cardiovascular
  complications from diabetes
• LDL-C is bad cholesterol and is usually
  measured as part of a panel of lipid tests
• Regular testing provides the member and the
  members doctor with important information to
  guide and measure the effectiveness of treatment

54
HEDIS Performance Metrics

• Care Select Initiatives to Increase A1C and LDL-C
  Testing for Members with Diabetes
• Disease Management (DM) program provides
• Disease and treatment education
• Support for achieving self-management goals
• Reminders for regular testing
• Coordination with PMP, schools
• Member Incentives
• Active participation in their Diabetes DM program
• Completing their A1C and LDL-C tests
• PMP Incentives
• Active participation in their members DM program
• Ensuring their assigned members receive testing

55
HEDIS Performance Metrics

• Annual Dental Visit (ages 3-64)
• Planned Activity
• Increase rate of Dental Exams
• Scope and Population
• Members ages 3-64 who have had at least one
  dental visit within a calendar year.

56
HEDIS Performance Metrics

• Annual Dental Visit (ages 3-64)
• Rationale
• Dental care is one of the most prevalent unmet
  health needs in America today.
• Dental health is highly correlated with many
  other health concerns
• Loss of teeth
• Abscesses that shed bacteria in bloodstream
• Ulcers
• Malnutrition

57
HEDIS Performance Metrics

• Care Select Initiatives to Increase rate of
  Dental Exams
• Member Incentive to schedule and complete their
  annual dental exams
• Initiative to increase transportation access to
  ensure all members are able to get to their
  appointments
• Just-in-time education and assistance with
  appointments (during health screening and
  assessment, mailings, inbound calls for other
  reasons).

58
Online CM Provider Portals

• ADVANTAGE Care Select - Flexport
• What is Flexport?
• Flexport is a (PMP) Primary Medical Providers
  connection to comprehensive medical utilization
  information about ADVANTAGE Care Select members.
• It is a secure web-based portal supplying the
  designated PMPs access to important and timely
  member utilization data. (Examples emergency
  room visits, PMP visits, Specialist visits, and
  medications filled)
• Flexport is an efficient tool to view a members
  comprehensive medical profile and provide input,
  on the Case Plan, to the Case Manager

59
Online CM Provider Portals

• ADVANTAGE Care Select Flexport (cont.)
• Why use Flexport?
• Flexports comprehensive medical utilization
  information provides a complete picture of a Care
  Select patients health status. This reinforces
  the benefit of having a medical home for
  ADVANTAGE Care Select members
• You and your staff will be able to save time by
• ? Having the care plan in one location
• ? Being able to view services the member is using
• ? Providing feedback for patient care plans
  directly and securely

60
Online CM Provider Portals

• ADVANTAGE Care Select Flexport (cont.)
• What Type of Information Is In Flexport?
• The Flexport member profile displays your
  ADVANTAGE Care Select patients use of services,
  prescriptions, and providers including
• ? Care Plans for each issue or condition
• ? Number of visits to PMP
• ? Number of visits to Specialists
• ? Primary and secondary diagnoses
• ? Inpatient admissions
• ? Emergency room utilization
• ? Durable medical equipment history
• ? Pharmaceutical history by drug classification

61
Online CM Provider Portals

• ADVANTAGE Care Select Flexport (cont.)
• What Flexport Is Not?
• Flexport is not a replacement for Indiana Care
  Select panel rosters. Refer to the roster sent to
  you twice monthly from EDS
• Flexport is not used to determine eligibility.
  Please continue to check eligibility of Care
  Select patients through Indiana Health Coverage
  Programs eligibility resources

62
Online CM Provider Portals

• ADVANTAGE Care Select Flexport (cont.)
• Enrollment Steps
• 1. Obtain a Web Portal Agreement
• visit the Provider page at www.advantageplan.com/
  advcareselect
• OR
• get the Agreement from your ADVANTAGE Care Select
  Provider Relations Representative
• 2. Complete and sign the Web Portal Agreement.
• 3. Fax or Mail the agreement to
• 317-587-8411 or
• ADVANTAGE Care Select Attn Provider Relations
• 9045 River Road, Suite 200
• Indianapolis, IN 46240
• 4. When the agreement is received you will be
  sent a confirmation letter with your user name
  and password
• User Name and Password cannot be changed. They
  are preset by the system

63
Online CM Provider Portals

• MDwise Care Select CareConnectNX (CCNX)
• What is CCNX?
• CCNX provides access for MDwise Primary Medical
  Providers (PMP) to their assigned members Care
  Plan and medical utilization information. It is a
  secure web-based portal supplying the designated
  PMPs access to important and timely member
  utilization data (Examples emergency room
  visits, PMP visits, Specialist visits, and
  medications filled)
• CCNX is an efficient tool to view a members
  comprehensive medical profile, provide input on
  the Care Plan to the Case Manager either during
  the care coordination conference or at any point
• You and your staff will be able to save time by
• ? Having the care plan in one location
• ? Being able to view services the member is using
• ? Providing feedback for patient care plans
  directly and securely

64
Online CM Provider Portals

• MDwise Care Select CareConnectNX (CCNX)
• What Type of Information Is In CCNX?
• The CCNX member profile displays your MDwise
  Care Select patients use of services,
  prescriptions, and providers including
• ? Care plans
• ? Case notes and progress notes
• ? Initial and full assessments
• ? Primary and secondary diagnoses
• ? Inpatient admissions
• ? Emergency room utilization
• ? Pharmaceutical history
• Note PMPs will eventually be able to add
  information to the members profile

65
Online CM Provider Portals

• MDwise Care Select CareConnectNX (CCNX)
• Enrollment Steps
• 1. Obtain a Web Portal Agreement
• visit the Provider page at www.mdwise.org
• 2. Complete and sign the Web Portal Agreement
• 3. Fax or Mail the agreement to
• 1-877-822-7188 or 317-822-7519
• MDwise Care Select
• Attn Jeff Leathers
• 1099 N. Meridian St., Suite 320
• Indianapolis, Indiana 46204
• When the agreement is received you will be sent a
  confirmation e-mail with your user name and
  password
• CCNX is not an eligibility verification or panel
  roster maintenance tool

66
Question Answer

• Presentation by ADVANTAGE Health Solutions, Inc.
  and MDwise, Inc. Provider Relations Team in
  cooperation with each organizations Care
  Management Department
• Janet Edwards SeniorManager Care Management,
  MDwise Care Select
• Kristin Atkinson Care Management Manager,
  ADVANTAGE Care Select
• Kelvin Orr Director of Network Development
  ADVANTAGE Care Select
• Chris Kern Provider Relations Manager MDwise
  Care Select
• ADVANTAGE Traditional Medicaid
• P.O. Box 40789
• Indianapolis, IN 46240
• ADVANTAGE Care Select
• P.O. Box 80068
• Indianapolis, IN 46280
• MDwise Care Select
• P.O. Box 44214
• Indianapolis, IN 46244