Commonwealth Coordinated Care Plus Town Hall Meeting / HealthChoice

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good morning everyone good morning I just wanted to if everyone can just kind of make your way to your seats we're gonna bring in some more chairs and I see we have our interpreter here I didn't get to meet her you have to we have we have interpreters services for sign language here today so if

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anyone is in need of sign language interpreter services we will be it will be up here so if you all could just make your way to your seats again we are bringing more chairs and also if you all did not get a index card to write questions you can raise your hand and we

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will get you one I'll come member thank you so I have some folks helping me get these index cards out so you can just keep your hands up and the index cards will be for asking questions we're still going to do the normal Q&A but we wanted people to have the ability to ask questions and writing and we'll take

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those up after the presentation one more thing if you're if you're if your presentation says provider instead of member we want to make sure we give you the right presentation so if you could take a look and if you have one that says provider you can raise your hand

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and we will take that from you and give you the correct presentation that's good news people are left out there so I'm going to take you would do that kaydee do we still have a few people out there it can I ask if anyone has an empty chair next to the next to you if you could raise your hand oh wow thanks

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so much so that people can can get their seats my name is Lynn vest and I'm where I'm with the department of medical assistant services which we also refer to as Dee Mass there are quite a few acronyms again my name is Lynn vest and also with me is Katie Hill I'll let her give her introduction good morning I'm Katie Hill I'm integrated care senior advisor from D Mass and I'm so excited

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to see all of you here today and we're just getting settled with a few more chairs but we wanted to let you know that this morning's presentation will be filmed and be broadcasted on the Internet and to some of our senior centers in the area so that we can extend the reach beyond these walls and the camera will be on the presenters so the audience will not be filmed and we're going to film the presentation part where Medicaid is speaking and then each of the six health plans and then we'll shut the cameras off during our

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question and answer period so you can feel free to jot questions down on your note card or you can ask a question once we open it up at the end for the question and answer period just a few housekeeping things if you have a cell phone if you could put it on mute or silent or vibrate we would greatly appreciate that and also the restrooms are just - probably your right my left out and then to the right right outside

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the door all right well if you guys are ready I'm ready because I know that you have a lot of questions this is a new program but we are here to help so even if you know you you need have questions that you feel like aren't answered we are here and we will be here for you after so we just wanted you to know that so if any of you here today or anyone who we're live-streaming to senior centers receive

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Medicare benefits only and do not receive Medicaid this program will not impact you at all because this is a Medicaid program so I just wanted to make sure everyone was aware that the CCC plus program which stands for Commonwealth coordinated care plus is a Medicaid managed care program okay so I wanted to definitely put that out there okay so the primary goal of if you don't

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mind me saying CCC plus because I'll get tongue-tied after a while is a program to improve health outcomes and there are many ways that we see that happening one is the new benefit which is care coordination in the past and even present those members that receive Medicaid benefits did not have care coordination or do not have care coordination there's not someone to navigate the health care system there's not someone to make sure when discharge

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planning happens or transitions of care in our lives just someone to ask someone to advocate some of us have that and some of us don't but this is a new benefit and it is no cost to the member the ccc plus program is a required program for those that are receiving full Medicaid benefits it includes a person's medical behavioral health and long-term support services you will if you don't remember anything else I say

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you will receive this same Medicaid Services the same amount the duration and scope of Medicaid services that you have always received the health plans must again it's it's more that when you have your Medicaid services you can think of the health plans as an extension they are also they're just gonna be the folks that are providing your Medicaid benefits paying for your medicaid services this new Medicaid managed care program will cover over two hundred and sixteen thousand Virginians

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so another thing to add about Medicare so I told you that if you have Medicare only this would not be a program that is impacting you many many of our Medicaid members have both Medicaid and Medicare services if you are one of those members that have both Medicare and Medicaid and we refer to as dually eligible your Medicare services and that the way they are working today your doctors do not have to change okay

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so Medicare services stay the same because this is a Medicaid program it's not a Medicare program we just happened to have folks that have both Medicaid and Medicare so what that means is if you have your doctors and your specialists and that's what your Medicare was paying for and your Part D drugs that continues to stay the same that does not change Medicaid is the payer of last resort so first would be your Medicare benefit and then your Medicaid so so what are the advantages

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of CCC plus so I talked about care coordination a little bit I also want to point out that you have a choice of six health plans and those health plans are offering additional benefits and that is another thing that's a plus in the CCC plus program when you had fee-for-service you did not have an option if you're an adult to receive your dental benefits have been vision benefits glasses and all the additional enhanced benefits that the health plans are able to offer your care coordinator

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will help you get your needs met so we're not just looking at the medical needs of our members we're looking at community health needs you might have need for housing or transportation or food or other things that maybe we're kind of falling through the grant craps that is crap I had to do it at least you're laughing that's good falling through the cracks so we want to make sure that gaps in care but the gaps

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in care are are taken care of with this plan so transportation so transportation is is also a benefit that has been available to you through traditional Medicaid or fee-for-service so the health plan is also like I said we'll be covering transportation the thing to remember about transportation is each of the health plans have their own transportation network so when you choose a health plan and you receive

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your health plan card you can turn the back of your card over and that would be the number that you would call for your transportation and for those that are on receiving services through our develop one of our developmental disabilities waiver the thing that is different is your transportation will still be the same through logistic care for your developmental disability waiver services so a person that is on the DD waiver again transportation will be continued to be covered through logistic air but

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that same person if they needed to go to a doctor's appointment would use the health plan for their medical services transportation okay and again the same services that were covered under fee-for-service medicaid for transportation so stretch your transport wheelchair transport public transit vans taxis volunteer drivers the health plans were cover all of those services that traditional Medicaid was covering and

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standing orders will be honored so for example we have members that might be going to an Adult Day Program or a dialysis center three times a week and they've had a standing order through logistic here the health plans will also accept standing orders through their networks so who is in our CCC Plus program who are the populations so it is those members that are 65 and older on full Medicaid individuals living in nursing facilities adults and children with

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disabilities individuals in the CCC Plus waiver that was formerly the EDC D which is the elderly and disabled with consumer direction and tech waiver those two waivers are now combined and called the CCC plus waiver individuals and the three waivers that are serving the developmental disabilities populations are what we'd like to consider half in and half out of the CCC plus program because remember a few slides back I said those with developmental

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disabilities their services are carved out but they're medical for primary and acute like going to the doctor or seeing specialists going to the hospitals that is what the health plan is going to cover for those folks on the DD waiver folks that are on the CCC which is the Commonwealth coordinated care program that has been in going on since 2014 that's a Medicare Medicaid program that is ending December 31st and the

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medallion 3 which is another one of our Medicaid programs for the aged blind and disabled they will transition to CCC plus starting January 1st so as I said those that are on the e d c d waiver and the tech waiver they're now not two separate waivers one waiver combined to be called the commonwealth coordinated care plus waiver and that was effective

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July 1st 2007 17 and this is the array of services that someone on the CCC Plus waiver would benefit from so if they are eligible Adult Day personal assistance services respite care private duty nursing services facilitation the personal emergency response system and medication monitoring transition services transition services assistive technology and environmental modifications all

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combined under that one waiver so there's a little bit of change with that combination and I think both of those changes there's two are very positive if members who were on the elderly and disabled with consumer direction again the EDC D waiver they did not have access to assistive technology or environmental modifications prior to the CCC plus waiver coming together so that is now something that is available to

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those with e d c d waiver and those who were on the tech waiver could get respite hours up to I think it was 360 and now the folks on the tech waiver who are now part of this combined waiver get 480 hours so an increase of respite for those on the tech waiver and then the increase of assistive technology and environmental modifications for those on the EDC D waiver so I think that's really really a nice ad and then private duty nursing is also still available but

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a person who needs private duty nursing must still meet the criteria the current criteria for tech waiver so another slide again you you know still may have questions because it is a little confusing when we talk about carve-outs but those on the DD waivers the developmental disability would waiver when it comes to their transportation case management support coordination anything they're receiving under the DD waiver is carved out of this program

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so again business as usual doesn't mean that they're not in the CCC Plus program as well because again they're in for their medical services their hospital their doctors their specialists so the DD waiver services covered through early and periodic screening detection and treatment we call that epsdt and you can see why that includes also private duty nursing personal care and assistive technology so if these services are being covered

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again through the DD waiver they're going to continue to be covered through the DD waiver non waiver services they'll be covered under the health plans so this next slide is when I you'll hear me say carve out and you'll hear Katie say carve out I think later on down the road when we say carve out we don't mean that they're not these services are not in the program when we what we mean is that the services

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themselves are carved out but the person could still be in the CCC Plus program and then when the services are carved out it just means that they're gonna continue to be paid for by fee for service Medicaid that the health plans won't be paying for those services that are listed here so if someone will see a child is receiving their dental services through smiles for children they can still be in one of the health plans for all their other medical care but when they go and get the services through dental smiles for children it would just

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be business as usual and paid for by fee for service the same with the UA I pre-admission screening that's done by social services it's going to be continued to be done through social services therapeutic group homes school health services continue to as they are today and then there's the community mental health rehab services which we refer to as a lot of acronyms cm hrs and those are non-traditional mental health services and I think we have a slide on

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that coming up but we'll go through what those services are but they are carved out until January 1st and there are things like mental health skill building again non-traditional mental health services and right now magellan our behavioral health contractor will continue to manage those services and the way that they're paid for again will be the same as going through fee-for-service until January 1st and then those services the health plans will then be taking care of our non

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traditional behavioral health services but right now until January 1st its business as usual so we know this is a new program and so there are some built-in protections and one of the things we want you to know is that for up to the first 90 days health plans have to pay your current providers whether they're in network or not and so that's really important to know we want our your care to continue for your loved ones and for yourselves and you can just you know

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continue to go see your same doctors your health plan must provide as your health plan must find a provider for a service that you need whether they're in network or not and they must have providers that can serve you regardless of your needs due to language or disability if you live in a nursing facility or your loved one lives in a nursing facility at the time of enrollment they will not need to move even if that nursing facility is not networked they would be paid as an

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out-of-network provider and what usually happens in this circumstances the health plans in the nursing facility will work together to make sure that they can you know a single case agreement where they would you know be able to be paid so CCC's plus begins for this area Northern Virginia in Winchester December 1st of 2017 and for the CCC members that I talked about earlier that we're in a Medicare Medicaid plan which is not this

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one they will again transition January 1st and our medallion 3.0 members who are eligible due to age or disability will also start January 1st so the rest of the medicaid fee-for-service populations have rolled in regionally except for these folks here thank you very much Lin all right so you guys are probably here because you got a letter in the mail from Medicaid asking you to choose one of our six health plans and all six health plans are represented today so at the end of the

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session you'll get a chance to speak with them so you will be choosing a health plan for your medicaid services and there's two ways to make a change to your health plan so the the health plan that you are signed in your letter is an initial assignment so that just means that we had to make sure everyone got an initial assignment in case something got lost in the mail or the person wasn't able to make a decision before the 18th of the month we wanted them to start somewhere so you get to make a choice and you can do that by calling our

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helpline which is one eight four four three seven four nine one five nine so that's the helpline or you can do the same thing through the website you can choose a health plan through our enrollment website which is CCC PL u.s. va.com so you can call the helpline one eight four four three seven four nine

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one five nine or use the website CCC PLU s va.com and the other things you can do either through the helpline or the website is you can find out whether your provider is in network with a specific health plan so you can key in your providers name or phone number or you can ask over the phone and say you know is dr. Smith in-network with health plan a and they can let you know which of the health

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plans dr. Smith is in network with now remember you only need to be concerned about your Medicaid providers and whether your Medicaid providers are in network with the Medicaid health plan because if you see a provider with your Medicare then you can continue to see them because your Medicare is paying for that this is a screenshot of the enrollment website and so there's a learn section which you can learn about the health plans and they're added benefits which they'll tell you about today and then

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you can choose from health plans in your area and you can enroll online if you choose to all right so Lynne and I have been saying that if you have Medicare then your Medicare does not have to change we did want to let you know about an opportunity you have the option if you want to to change your Medicare to align your Medicare plan with the CCC plus health plan that

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you choose so if you want to do that and you can do that at any time you could do it now you could do it next year then you would look for the dual special needs plan and what a dual special needs plan is is it's a Medicare Advantage plan that was specifically designed for duals which is people with Medicare and Medicaid your dual special needs plan which we call a D snip covers your Part

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A your Part B and your prescription drug coverage Part D so that would be your Medicare plan if you choose to enroll in the dual special needs plan and you can talk with our health plans if you want to learn more or you can like I said you can make that change at any point moving forward so that does not need to be done before the 18th of the month what you do need what we would like you to do by the 18th of the month is choose your

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Medicaid health plan so everybody we want you to make a choice for your health plan for Medicaid so you may be wondering well why should I enroll in a dual special needs plan if I have Medicare what is that going to do for me well that way you're working with one health plan organization for both your Medicare and your Medicaid so it could help with the coordination of benefits so that you're only working with one organization and you also your providers so your

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doctors or your personal care or your home health whatever your whoever your providers are they also would only be working with one organization but that is your choice with the the Medicare and you can call 1-800 Medicare to enroll in a dual special needs plan you can use the medicare.gov website and then you can also call the virginia insurance counseling an Assistance Program ViCAP for help with your Medicare but again

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that decision doesn't need to be made this week if you don't want to the ViCAP number is [Music] well alright so what if I run into problems with my new health plan well the first person you want to call is your care coordinator so your care coordinator can help you with any access to services problems or if your providers are having trouble with their authorizations so your care coordinator is the first call if that's not working

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for you you can always submit a complaint or grievance to your health plan and you also have appeal rights so you can appeal any adverse decision to your health plan once you've exhausted that option then you still have your appeal rights through Medicaid so you can appeal through our state fair hearing process and the Commonwealth has the CCC plus advocates which are some

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people who work for the state but they don't work for Medicaid and they don't work for the health plans they are independent advocates that help Medicaid managed care members who live in healthcare facilities or assisted living or that get who receive home and community-based care and what these independent advocates can do is help you navigate the appeals process or help you get with you're having trouble with access to services you know maybe you haven't been able to get in touch with

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your care coordinator they can help you with those problems and we have Susan Johnson here today and she is one of our CCC Plus advocates she's in the back in the black and green so you're welcome to speak with her after and she can she and her team can help you with problem solving you know help you if you get a bill that you don't understand because you shouldn't be getting bills as a Medicaid member and then they can also track problems that are across the state

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and help us to figure out where we need to target our efforts so we're very grateful to have these advocates and these are just kind of some of the types of issues that they might help with timeliness of response from your health plan questions about your plan benefits or your bills and in helping with the Appeals or grievance process their contact information is here located in your slides their phone number is 1-855-249-9867 in the care plus and

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we're going to start off with our slides we're gonna have Jamie Swan which is our clinical director to go over the most pivotal piece to this planet that would be care coordination so if you can give her your undivided attention I'm sure it'd be some personal information how you guys so I don't know about you but how many of you feel a little concerned and scared and just generally confused about health care me too right I get it so this is where the care coordination

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piece comes in we have licensed health care professionals nurses social workers behavioral health professionals that and every single member in the Commonwealth coordinated care plan will get one of these care coordinators assigned to you or your loved one this is the person that can help guide you through this really sometimes confusing overwhelming scary medical stuff right like what what

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happens when you go to the pharmacy and you can't get the medication you need it's terrifying right I know I've cared for people that have chronic disabilities so wait what what do you do normally is you go oh gosh and you call your piece of here and you talk to the pharmacist and you still can't get anywhere in this plane what you do should pick up your phone and you call your anthem care coordinator and you say I can't get this medicine and then that person goes to work to solve that problem so our care coordinators will

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outreach to you you'll get a letter in just probably a short time that will tell you who your care coordinator is and how to reach them but they will outreach to you or your loved one and they will do we kind of do a variety of things some people we do face-to-face visits when there's a lot of needs some people we do telephonic visits but we'll get with you in your family and your care providers and the people who provide services in your home and we'll

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help you develop a plan for what your goals are when was the last time somebody said what is your goal for your healthcare it doesn't happen very often that's what we're here to do is identify and help you make and reach goals that you have for your health care so they'll get all those people around you but those support people those healthcare professor your family your loved ones your caretakers and we're going to come up with a plan and then that care

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coordinator is going to work with you to reach that goal I mean there's a lot of things that care coordinators can do help you with the pharmacy problems help you arrange transportation help you find a doctor but ultimately all of that is in pursuit of that goal that you set for yourself and that's care coordination so I hope that kind of helps you understand what makes this program unique I have worked with anthem for a number of years doing care coordination and this kind of

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role and we do a great job our care coordinators do just about anything for their members chase-down UPS trucks to get DME equipment for members I mean they do some crazy stuff they are committed to you and that's really what what makes this program special and what we're really excited about thanks Jamie and as we move to our next slide the

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question is what with us what will you get and with anthem serving the Medicaid population here in the state of Virginia as a leading medicaid provider for the past 20 years we have been very successful it's going back to Jamie's point in the transition of a lot of our members from whatever they may be in now to the actual Commonwealth coordinated care plus most importantly as you look through your plans one of the biggest factors is your

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provider network you want to make sure your providers are networking with anthem we have a robust network for the state of Virginia over 25,000 providers which means more than likely your provider is in our network and if they're not through Jamie's Department you have specialized passionate care coordinators that we work diligently with the caregivers and also with family members to see if your provider will be willing to come in to the network you will have all your Medicaid benefits and added benefits and it goes back to the first try what you see in the picture is

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it says anthem is more than just a health plan and when you look at the value the benefits you can see we noticed that dental is very important hearing is very important we give those options and those benefits you have the smartphone but one thing I want to kind of ride on it is the transportation piece and we hold quality members with our members to ask them what they like and what they don't like and this is the president Common Wealth coordinated care members that's gonna transition on January 1st and the biggest thing they said it to us at these meetings were transportation especially you deal with rural areas is

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the lack of just reliable transportation so we made a change in 2015 to a contractor and with that we wanted to make sure that our seniors and our individuals that's in the plan we realized that health is important going to your daughter's and doing preventive care but the most essential thing to life is being social and being amongst like-minded individuals so what we tried and we test piloted in 2016 was to have for community trips to have our members to go somewhere outside of just doctors and pharmacies and because of the very

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response of what we received my members we decided as we move into the CCC plus that we're adding the additional eight so with 12 community trips our members are able to go to church they can go and get their hair done they can go to a community event they can go to a bingo event but this allows a lot about seniors to not be isolated and the worst form of a health declined individual is someone that's stuck in the house that does not have an out or to have anyone to come and see about them and a lot of our individuals that's notthat's out

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members I know me personally as a man I have pride I hate to ask anybody to do anything for me so with this I don't have to ask my next-door neighbor I don't have to beg my son and my daughter or a friend to come get me you have that service through the transportation which would be those 12 additional community trips speaking on the slides that demand supernovae with earlier we will be offering I do a special knees plan it will be called the anthem Eddie blue dual Advantage plan and the reason why this is so important because allows all of your Medicare Medicaid benefits to

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tunnel through one particular entity which simplifies the care coordination piece that way you know that all branches of your health care are communicating and they're on the same Paige and if you need more information regarding to do a special needs plan we have a team of experts they will be willing to answer those questions for you as well so last slide a helpful support team that you can actually reach and one thing in life I hate is calling a company and I'm on hold for two hours and I bumped around 20 times and still

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can't get my answer and it takes two weeks to get an answer or something resolved but this is a live person that picks up the phone and I've said this their previous Town Hall's and I know what kind of cringes a lot of people when I first had my daughter I wish I had this number because it was a scary experience when I came home a new baby my mom and dad promised me that hey we're gonna walk through the fire with you with this daughter and soon as we got in the house the baby start crying they walked out and said hey we see that y'all need some sleep I said you're not helping us we need you here but it

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always would seem on Friday Saturday nights or Sunday when I know the pediatrician is not available that my baby would start crying at 10 11 o'clock at nights at two o'clock in the morning so I'm up one in two o'clock googling trying to find out what's wrong with my child running the CVS to see if I can find some type of remedy to keep it from crying but if I had a 1-800 number to call that expert your primary care physician we can walk through this together and I can see all your providers I could see the medication

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that you're taking but you will have a live person on the phone that can assist you with that so that's most important and between that and the care coordination piece I can promise you that will help benefit it we have seen over the past three years with the Commonwealth coordinated care the lack of our members not using the care coordinator so out of all the players you hear today care coordination is the key to making this process effective and to work efficiently for you we would love to have you part of the anthem family so if you decide to come over please come to our table we have a wealth of

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information that we could provide like I said a team of experts you can also call the 1-800 for number go to our website if you desire to change and hopefully I'll you'll be a part of the anthem family thank you and we will have Magellan and will come next and at this point we just want to we just want to check to see if anybody needs the interpretive services so if you'll just raise your hand if you are using the sign language services we have

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here today all right thank you hi everyone how's everyone doing today so my name is Kirsten Bickford I'm here as a representative from Magellan complete care of Virginia I'm actually in charge of consumer directed services I know I'll probably be talking to a lot of our members about you know ppl but today I wanted to talk about Magellan we are a new MCO so for CCC Plus we started again

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in August just like the rest of the plans I do want to focus on the fact that we are person-centered community focused and evidence-based so every decision that we make we you know think about the member how does this affect the members experience and the member is really at the center of everything that we do so we're the health plan that puts you at the center of everything as anthem said earlier I'm sure there's a lot of concern and a little bit of anxiety about the changes that are coming so we just want to make sure that

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all of the changes that are happening you guys have the smoothest transition possible so our goal is for all of our members that have a smooth transition into MCC of Virginia so that is facilitated by the continuity of care period the D mass is set up will work with you your providers your prescriptions any you know facilities or long-term services and supports that you received to make sure that you're continuing to receive these you know from day one all the way through day 90 and then also on these services our

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continued after you enroll with us we also focus on making sure that our members live a vibrant and healthy life as independently as possible so your care coordinator and the rest of our team will work with you to make sure that you're meeting your goals you know coming up with new goals so that is a big focus here at Magellan as well another time another thing to point out about Magellan is that we like to make sure that all of our members have choice and control over your lives so like to give you you know a choice of different providers you know maybe we

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can work with you to come up with a different solution in case you know maybe your provider is a network we can help you you know contract with them or you know feels facilitate a single case agreement so that you can can you to see your doctors we do have a member services line that you can call with any questions about Magellan so you can reach out to us to see if you're a providers and network if your prescription is covered any questions that you have you can reach out to our member services line which is 1-800 for

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two four four five two four we also have a nurse line so if you have any medical questions you know maybe like he said if it's like 11:00 p.m. on a Saturday night you're not feeling well you can call our nurse line will transfer you and you can get you know kind of immediate attention over the phone we can transfer you to our pharmacy provider and any questions you may have about your long-term services and supports we can also help with that over the phone okay so this I

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really want to focus on the slide I think this is something that really differentiates us from the other plans so we have what we call an integrated health neighborhood so we have worked in each community in each neighborhood throughout the state of Virginia to make sure that not only is your provider a network but that we're aware of all of the resources within your community so this isn't this could include your church you know maybe your local school system if your child is in the program food banks anything really to help you be connected to the community and make

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sure that you know we're really living the most vibrant and healthy life as possible so this is our integrated health neighborhood you can see that you and your care coordinator at the center of it we have provider support specialists so if your provider is having any you know concerns with the transition those are the folks that would go out and help your provider weave community outreach specialists who come to events like this and also work at different events in the community we have health guides who can help you navigate through the system and are sort of like the care coordinators helper and then we also have peer in family support

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specialists for both my diction recovering and treatment services and then in January it'll also be for mental health and behavioral health services so at MCC in Virginia I keep saying this but you are at the center of everything at MCC of Virginia I'm so you and your care coordinator are sort of like a dynamic duo for the care coordination team so you know your care coordination team is comprised of you your care coordinator your provider and any of the other you know supports or specialists that you have that you see on a regular

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basis so when you first enroll with us you will receive a letter with your care coordinators name and phone number keep in mind you can always change your care coordinator we do is find them automatically your care coordinator will then reach out to you by phone they will want to get to know you look I don't want to get to know you know what are your goals what would you like to do by the end of you know 2018 what are you know kind of some pipe dreams that you have so they're really want to get to know you they can even talk to your friends and family members if you're okay with that just to you know kind of understand where you're coming from and

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the context of your life your care coordinator will also perform a assessment with you to help determine what types of services you need and then they will you know kind of visit you they're really your resource for any questions that you have you can reach out to your care coordinator and I also want to touch on our added benefits from a gel and complete care Virginia so we do offer adults dental so this includes you know x-rays cleanings up to $1,500 per year we have vision services so you're able to get glasses or contact

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lenses all of our members are potentially eligible for smart phones where you can get free text so you can get appointment reminders for members that are transitioning from you know being in a non waiver status to a waiver we can also provide those waiver services in the interim until your eligibility changes fresh meals are delivered to your house let's say you were in a hospital or a nursing facility during that discharge planning we'll make sure that you have fresh meals so that you know when you're home you're not worried

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about what you're going to be eating for that first week we also cover environmental and home modifications another thing that really sticks out is that we have an online cognitive behavioral therapy program so you can you know kind of on your own time you can address any behavioral health problems so maybe you have anxiety depression you can go to our website and find out more about that I also want to point out that Magellan will be ad snip in January of 2019 so not this coming

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near but one year from now we will be an available decent for you to select so any questions you have about Magellan at your gun you can call our member services line you can also go to our website which is MCC of va.com you can look at our provider directory on there to see if your providers and network and you can look at our preferred drug list to see if your prescriptions are covered really anything on that website and anything any other questions you have can reach out to our member services line or your care coordinator so thank you guys so much I really appreciate

48:23

your time today next we have Optima good morning how's everybody doing today good okay my name is Amanda Becker I'm the director of behavioral health for optimal health care and with me is my one of my team coordinators of Northern Virginia and we are here to kind of tell you a little bit off to my help optima health is born and raised in Virginia we've been in Medicaid since 1995 we're part of an integrated health

48:59

care system with Sentara Healthcare and we're very excited about the CCC plus now this is kind of an interactive thing whoo what is the only constant in life change right what causes us the most amount of anxiety change so what we do constantly is the one that causes us to the most anxiety this is an amazing program have you heard from all the other managed care organizations this is a member focus is about you and your family and being able to take care of you but I will tell you that it's a new

49:31

program right all new programs have issues or problems that come along but what you have is a lifeline with care coordination so whenever you have a problem or you think there might be an issue you need to call right call advocate for yourself or your family members because we can't help you if we don't know what the issue is right so if you have a problem you're gonna do what good job I'm terrible at powerpoints and I forgot I have one so here we go

50:01

okay we have a lot of our information on our website so if you have questions about services or providers that's on our website as well so you can look at that we have the added benefits just like the other managed care organizations do we do pest control we do meals after you've been in the hospital different things like that so if there's things that you need your care coordinator again it's gonna be your key right so if you have a problem when you need something like this what

50:30

are you gonna do call good job okay you tried to lied about the model of care about the care coordinator is gonna be your key all the managed care organizations including Optima have one phone number that you can call to reach for someone to help you someone who can get you in contact with your care coordinator or it can help problem solve things that you have right now so if something comes up and you need extra assistance you're gonna do what good job by the end of this you guys will be so good right okay 90 days continuity of

51:04

care this is really important this means that everything that you have going on right now is gonna stay right but again this gives our care coordinator time to meet you and find out who your providers are and who's helping you and what's your team and likewise it gives you a chance to know who your care coordinator is so during that 90 days if you have certain providers you have any questions or concerns and you want to make sure that your providers know that you're gonna continue to be able to have these services and we want to get all those providers in our network you're gonna make sure that you're gonna what call

51:35

right because we want to make sure that we have communication communication is the key we can help you and we want to help do what we can to advocate for you have the best outcomes that you can have whatever those are for you right that's what it's all about you guys you and families that's what this is about oh there's United so if you need anything what are you gonna do call and we hope if you have any questions we're in the back but up to the health care thank you so much for having us and I'm gonna turn

52:07

it over to you now good morning I can see some of you in the back I think I see you just want to thank you for coming out today I'm so excited to see such a great turnout that lets me know that you care about the health care choices that are available to you with the CC plus plan so in United our mission is to help change and help

52:46

people live healthier lives every day so you've heard a lot about this term care coordination what exactly has and what is exactly how can that really benefit you so I'm going to talk to you about a we'll call this man named Joe Joe is a patient that I had work with for many years and he had some very complicated and complex health conditions one was he had heart failure which means he also had a lot of clots that would form in

53:19

his body in his blood and he was on medication very serious medications he also was diet diabetic and Joe's medication really wasn't helping him because he didn't really have someone to give sort of that oversight he would go to the emergency room then he'd go to a cardiology doctor then he'd go to his primary care physician and guess what they weren't talking there wasn't a central point of entry to kind of look at what was really going on

53:49

with Joe so unfortunately what happened for Joe because one doctor put him on a different med and it caused him to have a blood clot that went to his brain so as a result Joe had a stroke and I often wonder and have wondered since that time if he had had that care coordinator to kind of oversee his care and look at all those medications and reconcile them and kind of determine whether or not he was

54:22

really getting the best plan of treatment so you ask why care coordination that's one really good example and now the next question why United so it United we are going to be your primary advocate for your families or your individuals needs for working with your medical team to coordinate those needs and as I said you can see why that would be really important for any of you that might have some complex health conditions or even if you just

54:52

need to get transportation services has anyone ever called to get transportation services or you know a number like my counterpart from an anthem setting you're on this phone queue or tree and you can't get through well we have a central point of entry for that we're also going to talk to health risk assessments that's very important because there might be things that you're not aware of that we provide at United or there might be some sort of service that can help you and we have that care coordinator to help you linked your to that service we also are going

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to review any benefits that you might be eligible for like I said we have a whole raya things within United we're a very broad company and we've done this kind of work in many other states very successfully we also are going to look at any food or housing needs that you might have and sometimes everyone needs that help so we have resources that we can connect you to so if you look at the value added benefits from United you get

55:58

dental care to screenings cleanings and lots one set each year and Weight Watchers you have baby blocks for prenatal care with incentives for making your baby appointments you have an eye exams you have a health line and you also have a mobile app that you can secure with get secure messaging for help tips your healthcare team you have an alert alehrer quit for life for smoking cessation transportation as I said and every time you go into the hospital you

56:30

have 14 prepackaged meals delivered to your home upon discharge because when you get home from the hospital you really don't feel like cooking usually so that comes to your door free of charge next slide so if you have any questions who do you call well United we have a member services line eight six six six two two seven nine eight two if you have any questions you can call that lot that number if you want to change your benefits or if you just in general have questions scheduled

57:00

appointment make sure that you want to see your primary care physician you can also call the nurse line that nurse line is available 24 hours a day seven days a week with a live nurse that's going to be there to help you and provide you support we also have mental health and substance abuse services that are available 24 hours a day seven days a week so the other benefit and I don't know if you can see this this is a huge

57:30

benefit if you're in the dual needs plan and you're with us for the dual needs plan you get not only in the dental do you get cleanings and partial dentures or feelings or feelings you get annual credit toward fillings crowns and a lot more services so yes it's in our talk to you well we'll take that question at our table I have a whole lot of colleagues

58:02

in the back and we will certainly address that we also have a personal response system so if you're home alone and you don't have anyone with you and you you know there's anyone ever heard that remember that commercial I've fallen I can't get up anyone you remember that yeah so this is your purse that'll help you if you do have any kind of health care need and it's available to you 24/7 seven days a week their health cross health care products catalog as I said the nurse line there's also a

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acupuncture services available visions we talked about transportation and chiropractic care for affordable chiropractic care is available to you so I'm really excited about you being here and I'm really excited for you to come back to our table over the people that you United raise your hand we have a whole team of professionals that are welcome welcoming you and we will be happy to take any of your questions after this thank you thank you

59:06

our next health plan is Virginia premier and then we have Aetna and then it'll be time for our question and answer so thank you for your patience good morning my name is Mary Korb and I'm the director of member services at Virginia premier health plan if you're not familiar with Virginia premier I'd like to tell you a little bit about our company we are a not-for-profit Medicaid managed care organization owned by the Virginia Commonwealth University Health System we have been working in the managed care with Medicaid recipients

59:38

area for over 20 years and we have over 200,000 lives insured currently across all of our lines of business we as well have a member services department eight seven seven seven one nine seven three five eight and we are there all the time during the day time to answer your questions that is also our number where you would be able to reach our nurse line as the other plans have mentioned we want to be able to assist you night or day with any emergency type issues you may have when you call member services we can explain to you what your covered benefits are help you get a

01:00:10

replacement ID card help you find a pcp and we actually have an our own internal transportation department so once you've spoken with the Member Services about any questions you may have or scheduled an appointment they can go ahead and schedule your transportation for you as well so when you hang up the phone you're ready for your appointment and to go see your provider we have a website where we are able to view our member handbook look at our provider directory if you have questions about whether your provider is in our network and we're also able at our member services number to send these documents to you as well if you're one of those folks like me who

01:00:41

likes to have a hard copy and make notes and draw lines so we're able to do that for you now you heard a lot about the role of the care coordinator and as every plane is mentioned that is a critical piece of this business and all of us will provide you with a care coordinator it is it is the mission of this plan by D mass for us to make sure that everyone is as healthy as they can be and the care coordinator is critical to that process they will meet with you at the beginning of your assignment with our company do an assessment either by phone or in person and talk to you about your goals and that's not the only assessment once

01:01:12

we've treated you once you've had some some time to to get some treatment attitude go through some of the goals that you've set will do reassessments to make sure that you're still on track or that your goals haven't changed or if your needs have changed that we don't continue on a path that's that's not exactly right for you now so a reassessment period is important as well because we know as time goes people's health needs change or their goals may change because we are we are local in the state of Virginia here and we are our care coordinators are in your area they're able to provide you with direction to services in the community

01:01:44

if it's something that you need housing or any type of services that might not be something that the plan is providing but that is a community service these care coordinators are very well in touch with all of the local social services agencies you can make sure that they help you find everything that you need um and also they'll advocate with you as the other plans have mentioned they're your primary point of contact to make sure that your doctors all of them are are working together that everyone knows where you then what's going on with you and that someone is looking out for you and will work with you if you already

01:02:15

have care coordination or a personal assistant we don't want to to disturb anything that's working well for you so there's no you know we'll loop that person in as well so that whatever you've got that's working well we want to keep that working well but if we can make things better that's what the care coordinators job is like some of the other plans we have some added benefits we know these things are important and this is one of the beautiful parts of the of the CCC Plus program is that not only do you keep everything about your Medicaid that you've had currently but

01:02:46

you get a lot of added benefits i'm dental vision we also will provide our members with a cell phone we provide gift cards for meeting some of your health goals going to your your routine you know appointments for screenings and the things keep you healthy we want you to know that that's a we appreciate that that being healthy is the goal of this program so we'll award you with some gift cards for that the food assistance as well and then premier wellness is our disease management smoking cessation qualifying members can have gym memberships those type things anything

01:03:17

that we know that would benefit you and will be important to keeping you healthy and unfit for the plan as these people from DMS have mentioned we are also able to provide decent Abdulle special needs plan coverage for you as well Virginia premier has been operating a dual special needs plan since last October so if you are someone who receives both Medicare and Medicaid we can manage your Medicare benefits as well we can talk to you about that at our table at the end that we are currently offering that and

01:03:47

as they mentioned the beauty of that is that you have one care coordinator they can coordinate your benefits so that that when you have doctors and and covered services on different than the different plans we can coordinate that for you and make sure that everything goes smoothly with both of your coverages we'll be at the table at the back we have we're very excited about this program I know that everyone here is probably a little confused and maybe a little nervous but there's not you have nothing to lose everything about your current Medicaid it stays the same and you have only things to gain which is someone who cares about your health

01:04:18

wants to make sure that you're healthy and can provide you with extra services that you don't get today so please come back to our table at the end thank you all right if Aetna will come join us we'll hear from our last health plan for today and continue to hold your cards up if you have any questions we'll pick those up hello my name is Karissa and I'm member service supervisor with Aetna I want to go over some of the members services options that we have with that now we

01:05:07

are here 24 hours a day seven days a week our telephone number is 1 8 5 5 6 5 to 8 2 4 9 where you can call and get general questions about benefits and services transportation we have a 24-hour nurse line care coordination you can call to request member information your handbook ID and we also have an app where you can go on and be able to also change your provider or basically it's any questions

01:05:39

that you would have we also have the app for you for a smart phone with all the plans we also come with care coordinator which I do have two with me today that will be able to go over some of the added benefits hi my name is thank you hi my name is agent one of the care coordinators with Aetna better health of Virginia where usual well my cell phone based out of the Richmond office however your new office in the Northern Virginia area will be open December first so you

01:06:09

you guys should be receiving letters soon regarding - who's your care coordinator is so care coordination what a lot of people do not realize it is a free service with your insurance plan and we basically we help address any needs that you may have whether it's medical needs social needs we help with I know some providers already went through this I don't want to sound like I'm beating a dead horse but talked about pharmacy issues issues regarding

01:06:41

pre authorizations for the MU equipment it's with you know quite a range of things it's never a dull moment definitely and care coordination we also our main job is that we like to link you to other resources within the community so one of the major components that we have is our community health workers which every region we'll be designated a few of them and they help with things such as helping

01:07:14

you with maybe getting a full pantry or safe housing or job training and we also have a workforce specialist within our health claim as well to help us with that we also have a major peer support specialist which is especially for our substance use and mental illness populations but those are just some of the services that we do provide with care coordinator kind of everyone said where you're part of the contact within

01:07:44

the health plan so once you find out who your care coordinator is that's the first step I think that's the biggest step and then we can so start helping address whatever needs that you and/or your loved ones may have and i'ma pass it on the cake because she could talk more about some of that added benefits hello my name is Kate Rollins I'm also a care coordinator with Aetna I know a lot of the other providers have talked about added benefits so it should be no surprise that we have them too I have a list here that's also going to be back

01:08:19

at our table so if you want a full list of all of our added benefits it can be obtained at our table it's a lot of the things you've already heard with some additional things highlights would be the adult vision and adult dental services which everyone's been really excited about we also have a wellness reward so you're already doing preventive care so why not get gift cards so you can go out to dinner you can also get assistance if you have diabetes you can also get diabetic shoes

01:08:49

in addition to adult hearing services and hearing aids in addition to the home delivered meals there's just a huge number of benefits that you can access with that now we also have wellness centers at each of our offices and that's going to be a place where anyone can come there'll be meeting space their computers and that's where our community health workers will reside so if you ever need anything there will be a Wellness Center where you can go and and meet with your character ordinary if you desire or to get any other service

01:09:20

that you need and same with the transportation and we also provide the home modification assistance I think we've got a couple more and last Aetna also do have all offer the decent program which our program would start January 2018 any more questions feel free to stop at a table and we'll be able to answer anything for you thank you thank you very much so at this point

01:09:53

we're going to transition into our question and answer period so we will be turning the cameras off and we're going to invite all the health plan representatives to come to the front and we're going to start working our way through the index cards to answer as many questions as we can today and we're going to leave some time for you guys to visit the health plans in the back as well so we'll do the group Q&A starting now

Commonwealth Coordinated Care Plus Town Hall Meeting

Table of Contents

More in Lectorium

SMALL BUSINESS

SENIOR PRESCRIPTION COVERAGE

DENTAL COVERAGE

SENIOR VISION COVERAGE