ACAP CEO Summit

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ACAP CEO Summit
Health Care Home Model Pamela Morris President
CEO
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CareSource

• Mission driven, Ohio-based, non-profit
  established in 1989
• 2nd largest Medicaid Plan in U.S.
• 21 years Medicaid managed care experience
• 840,000 members in Ohio and Michigan
• Strong Provider Network25,000 providers, 190
  hospitals
• Low administrative costs of 5

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Health Care Home Model

• Innovative reimbursement design
• Incorporates the value of CareSource so all
  practice sizes can participate
• Case management for high-risk or chronic
  conditions
• Health information technology to coordinate care
• Improved patient and physician engagement and
  outcomes
• Pay for quality
• Engagement
• Efficiency

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Our Design Challenge

• Adaptable to all practice types
• Wanted provider and
• member input
• Be part of the solution
• Dedicated Case Managers
• 24/7 nurse line
• Align incentives
• Outcome-based
• NCQA recognition
• Practice transformation

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Unique Model

• Representative provider configuration
• Not just early adopters
• All sizes of practices
• Medicaid member focus
• Scalable to all payer types
• Engagement and outcome-based reimbursement
• Relevant data
• Clinical practice registry
• Member profile
• Case Manager support
• On-site and virtual

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CareSource Health Care Home Model
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Case Management is Critical
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Health Care Home Reimbursement Model
Management Fee 40
Use of ER 30
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Program Roll Out

• Pilot Sites
• Dayton and Cleveland, Ohio
• Southeast Ohio and Michigan
• Pilot launchOctober 2009
• 40,000 members
• 23 practices
• Large and small practices
• Urban and rural
• 3 FQHCs

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Technology Supports Care Coordination

• Member Profile
• Provides easy access member history
• Easily updated
• Lists prescriptions, chronic conditions, etc.

• Clinical Registry
• Provides actionable health service data
• Encourages preventative care and creates
  awareness for physician

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Providers Value Health Care Home
Feeling like we are truly a partner. Working
together to make sure members get the most
appropriate care, at the most appropriate setting
and in a timely manner.
Identified asthmatics sent letters to schedule
Registry reports were used to call patients who
visited the ER
Reports used to understand specialist referrals
and medication usage
Pilot program for 72-hour post visit follow up
Provides real-time guidance
Registry identified those needing well care visits
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Discussion