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Magellan Complete CareThe Florida Medicaid specialty health plan that helps members get quality care for their mind & body.
OPEN MINDS Performance Management InstituteCEO MCC FL Manny Arisso, JD LHRM
Agenda Magellan Health :Mission and Vision
Magellan Complete Care: Who we are, Why we are, Where We are
First SMI Specialty Plan: Integrating Care for Success
Our Members
Our Model: Member Focus
Integration: The Partnership
Questions
Integration and Innovation working towards system transformation
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Why We’re Here‐Magellan Health
VISION Sparking innovation to build healthier and brighter futures
MISSIONMagellan guides individuals to make better decisions, and live healthier and more fulfilling lives, by improving the overall quality and affordability of healthcare.
GUIDINGPRINCIPLES
Member focused Provider partnerships Innovation oriented Passionate and responsible stewards Committed to the communities we serve.
Big NOBLE Purpose
Magellan HealthcareMagellan Healthcare• Behavioral health and substance abuse
• Integrated medical and behavioral care
• EAP and employer health and wellness
• Psychotropic drug management
• DOD/VA Programs• Magellan Complete Care
• Behavioral health and substance abuse
• Integrated medical and behavioral care
• EAP and employer health and wellness
• Psychotropic drug management
• DOD/VA Programs• Magellan Complete Care
NIA MagellanNIA Magellan• Advanced and non‐advanced imaging
• Cardiac • Radiation oncology• OB ultrasound • Emergency department• Pain management• Sleep management
• Advanced and non‐advanced imaging
• Cardiac • Radiation oncology• OB ultrasound • Emergency department• Pain management• Sleep management
Magellan RxMagellan Rx• Pharmacy benefit administration
• Medicaid formulary management
• Pharmacy claims administration
• CMS and supplemental rebate management
• Medical pharmacy• Specialty pharmacy
• Pharmacy benefit administration
• Medicaid formulary management
• Pharmacy claims administration
• CMS and supplemental rebate management
• Medical pharmacy• Specialty pharmacy
Who We Are ‐Magellan Health
Magellan Health is a healthcare management company that focuses on fast‐growing, complex and high‐cost areas of healthcare, with an emphasis on special population management. Magellan collaborates with providers to improve the health and well‐being of individuals and lower the cost of care.
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Magellan Complete Care
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The Case for Change
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Limited EngagementFragmented CareInequitable Access
Poor OutcomesCostly Programs
Personalized CareIntegrated Programs
24 / 7 AccessPositive OutcomesCost Effectiveness
Why We Are
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Saw a Need:Innovation in Integration
Policy Driven:Looking for the right solution.
Local Focus: Bottom Up Approach
Change: Working together to improve delivery of care
Member Focus
Magellan Complete Care …
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a unique offering that is specifically designed and focused to holistically care for individuals with chronic conditions .
a line of business separate from Magellan Behavioral, providing the full services of a Managed Care Organization.
a separate and distinct Strategic Business Unit at Magellan focused on the complete care of individuals.
a licensed Health Plan that manages integrated medical and behavioral health service.
IS the stapling together of Magellan Behavioral Health and some physical health management resources.
an extension of our current behavioral health programs that exist across the America..
IS NOT
Who We Are
Magellan Complete Care focuses on delivering a unique model to those most in need.
Health Plan
Magellan Complete Care is devoted to helping members feel better and enjoy a healthy life.
Our Commitment
Magellan Complete Care delivers and guides you through quality care for your mind and body
We Deliver
Where is Magellan Complete Care Today?
IOWA NEW YORKFLORIDAIn Iowa, MCC developed Integrated Health Homes. In these patient‐centered medical homes, MCC partners with community mental health centers and local federally qualified health centers to better coordinate behavioral and physical health services. Based on the success of pilot, the IHH program was expanded statewide with Section 2703 of the Affordable Care Act’s Integrated Health Home provision.
In Florida, MCC was selected to launch a Medicaid specialty health care plan that manages the medical and behavioral health benefits for individuals with SMI. The first of its kind in the nation, MCC has developed a results‐driven, community‐based approach to holistically address the health care needs of these special individuals.
In New York, MCC’s majority‐owned health plan is a Medicaid Managed Long‐Term Care Plan designed for chronically ill and disabled individuals who want to continue to live in their home, but need assistance with day‐to‐day health activities.
Beginning 1/1, MCC is participating in the New York Fully Integrated Duals Advantage (FIDA) Duals Demonstration Program.
Integrated Health Homes Nation’s 1st SMI Specialty Plan
MLTC, Medicare and Duals
FLORIDASMI Specialty Plan
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Magellan Complete Care ‐ Florida
Magellan Complete Care understands the unique mental and physical health needs of individuals living with Severe Mental Illness (SMI).
Our goal is to ensure that all members receive personalized, high‐quality healthcare that is tailored to their medical, mental health, and social needs.
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Magellan Complete
Care
Magellan Complete
Care
SMISMI
Chronic Health Issues
Chronic Health Issues
Social NeedsSocial Needs
Magellan Complete Care ‐ Goals
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• Improve the overall health, longevity and well‐being of the members living with serious mental illness
• Improve the overall health, longevity and well‐being of the members living with serious mental illness
ImproveImprove
•Providing better access, care coordination, and individual and family support for this special population
•Providing better access, care coordination, and individual and family support for this special population
ProvideProvide
•Decrease overutilization of institutional or facility‐based care and increase community tenure for these individuals
•Decrease overutilization of institutional or facility‐based care and increase community tenure for these individuals
DecreaseDecrease
•Create system transparency and accountability through data sharing and outcome tracking
•Create system transparency and accountability through data sharing and outcome tracking
CreateCreate
Eligibility
In order to be eligible for enrollment in Magellan Complete Care in Florida, applicants must have Medicaid benefits.
And be living with a Serious Mental Illness (SMI).
• Psychotic Disorders • Bipolar Disorders• Major Depression • Schizo‐affective Disorder• Obsessive‐compulsive Disorder • Delusional Disorder
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Effective 9/1 (Auto Assignment)Regions 2, 4, 5, 6
Effective 7/1Areas 10, 11
Effective 8/1Areas 7,9
JACKSON
CALHOUN
GADSDEN
GULF
LEON
WAKULLA
ALACHUA
BAKER
BAY
BRADFORD
BROWARD
CHARLOTTE
CITRUS
CLAY
COLLIER
DADE
DE SOTO
DIXIE
DUVAL
ESCAMBIA
FLAGLER
GILCHRIST
GLADES
HAMILTON
HARDEE
HENDRY
HERNANDO
HOLMES
INDIAN RIVER
JEFFERSON
LAFAYETTE
LAKE
LEE
LEVY
MADISON
MANATEE
MARION
MARTIN
MONROE
OKALOOSA
PALM BEACH
PASCO
PINELLAS POLK
PUTNAM
ST. JOHNS
SANTA ROSA
SARASOTA
SUMTER
SUWANNEETAYLORUNION
VOLUSIA
WALTON
LIBERTY
ORANGE
OSCEOLA
NASSAU
Region 2: Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, Washington
Region 4: Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia
Region 5: Pasco, Pinellas
Region 6: Hardee, Highlands, Hillsborough, Manatee, Polk
Region 10: Broward
Region 11: Miami‐Dade, Monroe
Region 7: Brevard, Orange, Osceola, Seminole
Region 9: Indian River, Martin, Okeechobee, Palm Beach, St. Lucie
MCC Florida Regional Map
Our Benefits
Member
Magellan Complete Care has many doctors and nurses who help our members keep good health. Your primary care physician (PCP) is your doctor that will manage all your health care.
Magellan Complete Care has a network of doctors, therapists, counselors and peer specialists who can help you with serious mental illnesses. They include:
Obsessive‐compulsive disorder Bipolar disorder
Schizophrenia Depression
Magellan Complete Care has a list of drugs your doctor can pick. The covered medicines include prescription and certain over‐the‐counter medicines. You can get prescriptions filled at a lot of pharmacies in our network.
Magellan Complete Care helps you with regular dental care to fight and prevent gum disease and cavities.
Magellan Complete Care vision services include eye exams, eyeglasses, and contact lenses, if needed.
Magellan Complete Care has programs to help you better understand and care for your chronic conditions. They include:
Asthma Congestive Heart Failure
Diabetes Cancer and Cancer Prevention
Magellan Complete Care can get you transportation to and from your medical, dental appointments and the pharmacy.
Enhanced/Expanded Benefits
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•Primary care visits for non‐pregnant adults•OB visits for routine pregnancy•Dental for adults •Vision services
General Health
•Home health visits for non‐pregnant adults•Intensive out patient for Substance Use disorder•Outpatient hospital services benefit expansion
Home Health & Out Patient
•Nutritional counseling•Post discharge meals•Healthy Behaviors Program
Nutrition
•Pneumonia, flu and shingles shots•Monthly benefit for over the counter products
Vaccines, Over the Counter Medication & Supplies
Our MembersThe Need
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Why we do what we do
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1 5in
Americans lives with mental health challenges
Why we do what we do
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60%of adults with any mental illness
are untreated
Why we do what we do
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40%of adults living with serious mental illness
receive no treatment
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40
60
80
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Our Focus ‐ SMI Population
Higher rates of modifiable risk factors
• Smoking • Alcohol consumption • Poor nutrition • Lack of exercise • Unsafe sexual behavior
Complex relationship between SMI and
medical conditions
• Interplay of drugs and conditions• Unaddressed physical health issues causing higher anxiety
Symptoms associated with SMI can impede getting
needed care
• Feelings of hopelessness and powerlessness• Fear of accessing care• Difficulty in following medical recommendations• Decreased motivation• Impaired communication skills
Alcohol and substance use disorders
• Co‐occur in 40 to 70% of individuals with SMI
Impact of psychotropic medications
• Cause metabolic syndrome, weight gain, and diabetes• Side effects can mask symptoms of medical illnesses
High rates of chronic medical conditions
• Cardiovascular disease• Diabetes • Obesity • Respiratory disease• Infectious disease• Musculoskeletal problems
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Comorbidity ‐ Creates the Need for Integrated Care
24%
34%
18%
35%
64%
0%
10%
20%
30%
40%
50%
60%
70%
SUD Respiratoryproblem
Diabetes Heartdisease
Obesity
Incidence of chronic co‐morbid medical conditions SMI
11%
62%
27%
SMI with multiple chronic conditions
Zero Conditions1–2 Conditions3+ Conditions
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Note: Prevalence rates of specific physical health conditions. n=12,385. Dark green data represents prevalence for general population in Arizona in 2011.
Note: Represents percentage of population with SUD, respiratory problems, diabetes, heart disease and/or obesity. n=12,385.
SMI Cost Profile Claims Data Set
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SMI Cost Profile: Top 3%Members
FFS PMHP Total FFSClaims Enctrs Expense Claims
Inpatient Physical Days / k 2,720 2,720 26,456ALOS 5.9 5.9 6.6PMPM $347 $347 26% $4,513 53%
Inpatient Behavioral Days / k 994 652 1,646 6,951ALOS 5.5 4.2 4.9 5.5PMPM $128 $50 $178 13% $1,098 13%
Emergency Room $70 $70 5% $239 3%
Outpat / Prof Physical $274 $274 20% $1,360 16%Outpat / Prof Behavioral $51 $71 $122 9% $124 1%
Rx Physical $209 $209 15% $979 11%Rx Behavioral $160 $160 12% $206 2%
Total PMPM $1,239 $121 $1,360 $8,517
Share of Total Spend 91% 9% 100% 30%
Our Commitment to Our Members
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CommitmentCommitment
Help navigate the system to reduce or eliminate barriers
for enrollees
Identify and address attention to high‐risk enrollees
Support members in self and health management and treatment adherence
Improve members’ ability to self‐manage chronic
conditions
Achieve healthy, meaningful lives
To Help AvoidTo Help Avoid
Adverse drug interactions
Duplicate tests
Frequent, unnecessary ER visits
To Improve Risk Factors
To Improve Risk Factors
Hypertension
Weight
Exercise
Glucose levels
Our ModelThe Difference
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Innovations in Action‐Model of Care Elements
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IntegratedHealthHome
MYLIFE
Peer Programs
Individualized Care Plans
Housing Programs
Self Directive
Care
Information SharingProvider
Network and
Payments
Smoking Cessation
Linkages to Social
Services
Field Staff Model (2/3)
Crisis Navigator
Mobile PhoneProgram
Care Coordination
Teams
Suicide Deterrent Jail
Diversion CIT
Whole Health Rx
Magellan Complete Care’s enhanced services result in a unique model of care tailored for this population that requires that we work much more collaboratively to share information, coordinate care, and provide support for the enrollees and providers.
Members of the Care Coordination Team
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We help members make appointments, arrange transportation to appointments, and adhere to treatment regimens.
Our peer support programs can help support the member’s health and wellness between appointments.
Resulting in improvement to the member’s overall health –mental and physical.
Provider Support
Specialists
Social Services
Network Contracting
Community Partnership
Community Outreach
Specialists
Provider Liaison
Personalized careClinical excellence
Person‐Centric Systems of Care for Better Health
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Communitypartnerships
Multi-modal
Riskstratification
Culturallycompetent
Value-based
networks
Integratedsolutions
BestOutcomes
Network Project-Worked with Medical Center to address credentialing needs
-Built a meaningful relationship with the practice via high touch approach
- Resolved contracting issues through teamwork
Engagement
CMHC Outreach-Outreached during CMHC project
- Locations in South Florida
- Working collaboration
- Provider educated me on their agency
- Staff explained the companies vision to expand services in Palm Beach county
Needs Assessment
PCP Outreach-Continued to meet with Medical Center to assess their readiness for an integrated model of care (SRA: 4.8)- Met with practice staff to build rapport and educate - Asked questions to understand the practice, their goals and strengths- Identified a large unmet mental health need (on avg. they have 1 Baker Act per week in their office)
Supportive Growth
Making the Connection-Collaborated with Medical Center to explore options to meet this critical patient need - Provider explained their “vision” for a solution based on their patient population, and current resources- Explained the spectrum of services by CMHC provides, location and goals for expansion- Connected the 2 providers to match their needs and goals
Connecting the dots… Provider Support SpecialistSeeing an opportunity for partnership every step of the way
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Teamwork
Case study for integration
Health Guide: Boots on the Street Impacting Lives
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Building ConfidenceHeart Condition, Bipolar, Smoker,Housing Instability…• ICCP, Setting of goals• PSS, Medication Adherence• PSS, PCP Appointments
Member empowerment.• Rx Adherence• PCP Visits• ER Reduction• Access to Dental Care
“I care because you are caring, thank you for caring.”
Building Member trust, sharing information, member advocacy.• Integrating Care via
sharing information.• Building awareness.• Member in care.
“You are the reason I feel motivated to change”
“I never get treated so
well!”
“She saved my life”
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Faceto Face
Integration:The Partnership
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Channels for Integration
Community
• Incentive/Integration Based Contracts
• Model of Care Integration• Information Hub‐ PSS/HG• ICT Meetings• Data & Analytics
• SAMHSA Integration Projects • Incentive Based Payments
• Coordination• Co‐Location• Integration
• Information Sharing
Member FocusBetter Outcomes
Improved HealthIncrease Tenure
Expand Delivery
Providers
MCC
• Linkages to Social Services • Community Outreach• Sharing of needs and supports.
First Lessons‐ Tearing down barriers for integration
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THIS IS REALLY HARD– CHANGE IS HARD
Co-Location
Does not mean coordination
Benefits soar beyond just health care
• Children Self harm behaviors dropped by 7%
• Caregivers absence at work dropped by 13%
• School attendance improved by 12%,children missing >2 days
DO IT LOCAL
Local community partnerships are
essential for integration.
The power of stigma, the need for education.
Working with Providers
Magellan Complete Care supports providers with services that help coordinate care, implement self‐care practices, and improve adherence to treatment plans for members living with SMI.
• We offer a fully integrated service model, information sharing
• We emphasizes prevention and early intervention, routine screenings, and whole health peer support to keep members healthy.
• Specialized chronic care improvement program for the diagnosed condition of the member.
• We assist with members getting appointments and in the process train and equip the internal practice staff on how to deal effectively with these individuals.
•We strive to simplify the delivery and administration of care so providers can do what they do best—treat patients and improve care.
Our Commitment to Our Providers
CollaborationCollaboration
We facilitate and coordinate care and treatment planning
Support for your practice to improve outcomes
Improved health care experience for enrollees
Alignment Alignment
Incentives with providers
Health assessments
Aftercare support
Care coordination
SupportSupport
Timely, accurate claims payment
Customer service and physician liaison
Member self‐management, education and healthy living
Dedicated provider support team
Comprehensive, online tools for easy plan administration
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Q & A
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