FinancingStrategiesforCareCoordinationwithintheMedicalHomeLindaBarnhartPublicHealthNursingConsultant,CSHCNProgram,DOHPatShawCSHCNCoordinator,ClarkCountyNovember2,2006GoalofpresentationUnderstandwherefinancingcarecoordinationfitswithinMedicalHomeStrategicPlanUnderstandthegoalofthecarecoordinationworkgroupBecomefamiliarwiththeactivitiesofthecarecoordinationworkgroupMedicalHomeStrategicPlanFinancingGoalGOAL:FinancingformedicalhomesisadequatetomeetthecarecoordinationneedsofchildrenwithspecialneedsStrategiesforMedicalHomeFinancingGoalConveneagroupofstakeholderstodevelopaneffectivestrategyforcarecoordinationreimbursementPilotreimbursementstrategiesdevelopedbystakeholdergroupUsefindingsfrompilotstoimplementsystemchanges

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MartinLutherKingGoalofCareCoordinationWorkgroupDefineaneffectivefinancingstrategyforcarecoordinationthroughoutthestateandmakerecommendationsWithinthemedicalhomemodelForchildrenandyouthwithspecialhealthcareneedsinWashingtonStateWorkgroup

MembersMedicaidDOHCSHCNFamilyVoicesWAChapterAAPMentalHealthDivisionOSPILocalCSHCNCoordinatorInfantToddler

EarlyInterventionProgramCenterforChildrenwithSpecialNeeds(CHRMC)RegenceGroupHealthKidsGetCareSofar… 5ConferenceCallsWorkplandevelopedClarificationofpurposeandrolesTargetpopulationidentifiedInformationgathering,instateandoutofstateTargetpopulationChildrenwithspecialhealthcareneedshaveorareatincreasedriskforachronicphysical,developmental,behavioral,oremotionalconditionandwhoalsorequirehealthandrelatedservicesofatypeoramountbeyondthatrequiredbychildrengenerallyWorkgroupHasAgreed:Carecoordination(CC)shouldoccurwithintheMedicalHomeCCshouldcommunicatewithotherCCandbeone“pointofcontact〞CCneedstohavetrainingand/orcredentialingQAprocessshouldbeinplaceWeneedmoreinformationoncurrentfinancing,what’sworking,whatarebarriersDiscoveringthecurrentCClandscapeQuestionnairessentto:HealthPlansStateAgenciesLocalAgenciesPediatrician11QuestionnairesreturnedQuestionsHowdoesyouragencysupportcarecoordination?Howdoyoufinancecarecoordination?WhatisworkingwellforCCinyouragency?Whatareyourchallengesorbarriers?Whatareyourstrategies?SupportofCCProvidingfundsforCareCoordinatorsorCaseManagersProvidingorientationandmentoringtonewCareCoordinatorsProvidingmethodsofidentificationofchildrenwithspecialhealthcareneeds(e.g.TitleV,pharmacy/claimsdata,referrals,practicedatabase)FinancingofCCFundedthroughfederal,state,orlocalgeneralfunddollarsFundedthroughpremiumschargedtopurchasersFundingstartedasgrantbutnowsupportedinternallyusingcostsavingsandexpandingpositionWhat’sworkingSomeoneisassignedtheroleofCareCoordinator(CC)orCaseManagerCCconnectschildrentoamedicalhome“What’sworking〞variesbecauseCCvaries,e.g.ICM,CCinMHclinic,locallevel,healthplans,developmentalofcareplansChallengesandBarriersNeedforcarecoordinationgreaterthanavailablefundingLimitedPublicHealthfundingManygroupswiththeirownfundingstreamsbutnooneCC“onfirst〞LimitedabilitytousefundsformorecarecoordinationbecauseoffederalrequirementsAttemptsatbillingforCCgenerallynotsuccessfulStrategiesPutforwarddecisionpackagesExample:HRSA—provideCCtofosterchildrenExample:HRSA—implementpilotprojectforhealthnavigatorsPrioritizecarecoordinationtochildrenwithgreatestneeds(HealthplansandlocalCSHCNprograms)CollectanduseoutcomedataobtainedfromcarecoordinationgranttosupportCC(KidsGetCare)ImplementpilotprojectsExample:MentalHealthDivision--usingevidence-basedpracticesDoyoureimburseforCC?OneHealthPlanreimbursesfornon-physicianencounters“ifallowedbycontract〞NoHealthPlanrespondentsreimbursefortelephoneoremailDSHS/HRSAmanagedcareprovidesadditionalpaymenttocontractedhealthplansforCSHCN;plansmaychoosetousefundingforhealthplancarecoordinationfunctionNextSteps…Con