Provider Educational
Seminar
Care Management: Part III
4/13/2015
4/13/2015
Care Management:
Health Promotion & Wellness
Overview:
• Health Education and Health Coaching for members
needing/wanting lifestyle management
• Provide information, guidance, and assistance on a variety of healthrelated topics
• Goal is to help member improve overall wellness and reduce risk of
disease
Presented by: Johns Hopkins HealthCare
4/13/2015
Care Management:
Health Promotion & Wellness
Health Education:
• Community and on-site classes
• Community coalition participation
• Consumer advisory board (Priority Partners)
• Health fairs
• Group programs on a variety of health topics including diabetes, asthma,
nutrition and obesity, smoking cessation, teen health, family planning, and
prenatal health
Presented by: Johns Hopkins HealthCare
4/13/2015
Care Management:
Health Promotion & Wellness
Health Coaching:
• One-on-one monthly coaching sessions for six or more months
• Convenient communication via telephone
• Work with member to develop personal health action plan
• Ongoing support and encouragement
• Available to USFHP and some EHP members only
• Work with members in Level 3
Presented by: Johns Hopkins HealthCare
4/13/2015
Care Management:
Health Promotion & Wellness
Identification through Health Risk Assessments:
• Now available online or by mail
• Upon completion member receives detailed Personal Wellness
Profile with overall wellness score, risk ratings, and
recommendations for improving health
• Direct contact with identified members
Presented by: Johns Hopkins HealthCare
4/13/2015
Care Management:
Special Needs Coordination
Priority Partners members with special needs include members
who are:
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Homeless
Physically or developmentally disabled
HIV/AIDS patients
Challenged to substance abuse problems
Language barriers
Pregnant women
Children who have a special health care need; in State-supervised
foster care; with elevated blood lead levels
Presented by: Johns Hopkins HealthCare
4/13/2015
HEDIS
• Healthcare Effectiveness Data and Information Set (HEDIS): a set of
key performance measures designed to provide employers,
government agencies, consumers, health plans and others with
information needed to compare the performance of managed care
organizations
• The National Committee for Quality Assurance (NCQA) directs the
HEDIS Program
Presented by: Johns Hopkins HealthCare
4/13/2015
HEDIS
• Methodology for data collection: calculation of the measures are
standardized across all plans, thereby allowing for comparisons
• Benchmarks supplied by NCQA used for comparison purposes are:
 The Maryland Average Reportable Rate 2005
 The National Medicaid HEDIS Means and Percentiles and
Quality Compass
• Plans are required to have data collection and methodologies
audited by an NCQA certified auditor to ensure standardization of
metrics
Presented by: Johns Hopkins HealthCare
4/13/2015
Care Management:
Case Management – Moderate Intensity
Overview:
• Initial assessment
• Health goal setting
• TeleWatch condition monitoring
• Medication adherence
• Provider and member feedback
Presented by: Johns Hopkins HealthCare
4/13/2015
Care Management:
Outreach
Overview:
• Answer member questions about benefits and access to care
• Education on importance of preventive health care, immunizations,
exams and diagnostics
• Improve members compliance/adherence with care (program and
appointment enrollment and follow-up)
• Refer members to health education, special needs and case
management for follow-up
Presented by: Johns Hopkins HealthCare
4/13/2015
Care Management:
Outreach
Process:
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Review and distribute Health Risk Assessments results based on
member status
•
Contact member (three attempts via phone and mail)
•
Identify barriers to care
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Conference call with provider and member to coordinate
appointment
•
Refer member to other care management divisions if appropriate
Presented by: Johns Hopkins HealthCare
4/13/2015
Care Management:
Outreach
Initiatives:
• Childhood immunizations
• Annual well-child visits
• Emergency room
• Prenatal/postpartum
• Adopt-a-clinic
• Referrals
• Transportation
Presented by: Johns Hopkins HealthCare
4/13/2015
Care Management:
Contact Information
Case Management:
• 1-800-557-6916 or populationhealth@jhhc.com
Health Promotion and Wellness:
• 1-800-957-9760 or healthcoach@jhhc.com
Outreach:
• 1-888-500-8786 or orferrals@jhhc.com
Special Needs:
• 1-800-261-2396, x 4906 or snc@jhhc.com
Utilization Management:
• 1-800-261-2421
Behavioral Health:
1-800-261-2429 or bhreferrals@jhhc.com
Presented by: Johns Hopkins HealthCare
4/13/2015