Dream, Empower, Achieve!
April 26, 2012
Our Experience
• Centene has 28 years experience
• Currently serves over 1.6 million Medicaid members
 This includes about 218,000 Aged, Blind and Disabled individuals
• Has health plans in over 15 states
Health Plans
Membership: 22,400
Membership: 433,100
Membership: 74,900
Membership: 215,800
Membership: 160,100
States with Health Plan Membership
States with Centene Operations
Implementing Health Plans
Centene Headquarters
Headquarters for CenCorp Companies
Centene Claims Processing Centers
Membership: 36,200
Membership: 90,300
Membership: 305,800
Health Plans not yet pictured:
• Home State Health Plan (MO)
• Coordinated Care (WA)
Membership: 194,900
IlliniCare’s Member with Developmental
Disabilities Profile
•
The “average” IlliniCare member with a developmental disability has the
following characteristics:
 Is Male
 Lives in Cook County
 Is on average 34 years old
•
Population Break Down:
 Sex
 Male: 60%
 Female: 40%
 County
 Cook: 67%
 Lake: 7%
 Will: 10%
 Kane: 5%
 DuPage: 8%
 Kankakee: 3%
The Integrated Care Dream
• Connecting a fragmented delivery system
 Bringing together medical, behavioral and social services
 Open communication between providers, member and health
plan
• Medical Home
 Member sees one Primary Care Physician and builds a strong
relationship with that provider
 That provider oversees health needs, helps with referrals,
specialty care, etc.
• Coordinating Care
 Linking members with needed services and providers
 Ensuring members get the right care, at the right time, in the right
setting
The Full Picture of Health
Social Services
Physical Health
Integrated
Care
Mental Health
Making the Integrated Care Dream a Reality
• Person-centered
 Care plan is unique to each member’s goals for their own health
 Services and programs are wrapped around the individual, customized to
their needs and preferences
• Integrated Team of Experts
 Assist members to navigate the system
 Work with current organizations/agencies as an additional advocate
 If members do not have this additional support, we will provide it
• Innovative Programs
 MemberConnections
 Connections Plus
 CentAccount
IlliniCare’s Model of Member-Centered Care
Medical
Director
Pharmacist
Medical PCP
Connections
Team
Community
Supports
MEMBER
24 Hr.
Nurse Advice
Line
Behavioral
Health
Provider
Community
Liaison
Integrated
Care Teams
Integrated Care Team
• Behavioral Health Service Coordinator
 Licensed clinician with experience in
service coordination
• Medical Service Coordinator
 Licensed RN clinician with experience
in service coordination
IlliniCare currently has nine
Integrated Care Teams
• Social Worker
 Licensed and non-licensed with experience in directly coordinating and
integrating the social/community needs of members
• Program Coordinator
 Helps the member navigate the system; assists in coordinating care, setting
up appointments, identifying physicians, etc.
Integrated Care Team – Focused on Members with
Developmental Disabilities
• Specialized experience
with individuals with
developmental disabilities
• Each individual is touched
by every member of the
team
• Team works together to
find solutions for members
Meet the Team:
• Noelle Ficarello, Program Specialist – Social Work
 10 years of Social Services experience
 Licensed Clinical Social Worker
 Worked at residential treatment center for children with emotional and behavioral disabilities,
adults with chronic mental illness, and adults with mental illness and a developmental
disability
Meet the Integrated Care Team
• Elizabeth Audiffred, Program Coordinator
 18 years experience
 Worked with low income families, care management and case worker programs
providing services to Medicaid enrollees
• Kathy Schneider, Medical Care Coordinator
 19 years experience
 Registered Nurse
 Worked in SNF, home health care and hospice. Worked for six years as the Health
Services Director for Community Living Services at Little Friends, Inc.
• Stacey Stewart, Behavioral Health Care Manager
 15 years experience
 Licensed Professional Clinical Counselor
 Worked directly with children, adolescents and adults with developmental
disabilities providing therapy and case management
 Providing counseling and support groups for caregivers of people with
developmental disabilities
Covered Benefits – Medical
• Doctor Care
 Yearly Physical Exams
 Specialists Visits
 Wellness Visits
 Diagnosis and treatment
 Immunizations (shots)
 Prenatal and postpartum care
• Medical Supplies:
 Durable Medical Equipment
 Disposable medical supplies
 Prosthetic devices
• Hospital Care
 Inpatient services
 Outpatient services
 Laboratory
 X-ray
 Diagnostic studies
 Emergency care
 Surgeries
• Other Covered Services:
 Physical Therapy
 Chiropractic care
 Occupational therapy
 Hospice
Covered Benefits – Dental & Vision
• Dental covers:
 Fillings
 X-Rays
 Crowns (caps)
 Annual cleaning
for adults
 Root canals
 Practice visits if
 Dentures
needed
 Extractions (pulling)
• Vision covers:
 Yearly eye exam
 1 pair of glasses per year
• IlliniCare Extra Benefits:
 Enhanced Frame Selection
 Contact Lenses
Physical Health – How We Help
• Integrated Care Team ensures members are in good physical health.
We help members with:
 PCP Relationship
 Assist in finding a PCP
 Working with providers that are
both in and out of network
 Educating providers on ICP,
continuity of care
 Annual Doctors Visits
 Educate members about procedures and
assist them to feel comfortable
 Explain tests, next steps
 Practice Visits for dental services
and OBGYN appointments
 Additional needs:
 Medical Equipment
 Dental
 Optical
 Preventive Health Screenings:
 Flu shots
 Immunizations
 Annual pap and
mammogram
 Colorectal cancer
screenings
Covered Benefits – Behavioral Health
• Behavioral Health services include:
 Mental Health assessments
 Psychological evaluations
 Treatment plan development
 Substance abuse treatment
 Crisis intervention
 Therapy
 Counseling
 Developmental testing
 Medication training
Behavioral Health – How We Help
• Mental health affects physical health. By addressing behavioral
health and medical issues together, we help members be healthier.
• Connect members with behavioral health services they need:




Psychiatry
Psycho-social rehab
Group therapy
Individual therapy




Medication management
Substance abuse
Smoking Cessation
Support Groups
• Connecting with community agencies – the member’s local care
management team
 Integrated Care Team doesn’t replace member’s current supports
 Additional advocate if needed
• Coaching – helping member understand services and process of
behavioral health appointments
Covered Benefits – Pharmacy
• Preferred Drug List
 Includes list of medications that are
covered by IlliniCare.
 Providers must prescribe the
medications on the PDL
 Exceptions made if it is
medically necessary
 Ensure covered medications are used
to treat a variety of conditions and
diseases
 Entire Preferred Drug List is
available online
• Over the counter drugs on
preferred drug list
 We will cover the cost if you have a
prescription from your physician
• Filling a prescription
 Use an in-network pharmacy
 Receive 90 day supply by mail
with RxDirect
Covered Benefits – Transportation
• IlliniCare will provide transportation
when needed. This includes:





Reimbursement of personal mileage
Door-to-Door service
PACE Service
Medi Transport
Public Transportation
• We will select the best transportation
method for the member’s needs based on:
 Proximity to the home/provider
 Accessibility needs
 Cost effectiveness
• Contact Member Services at
866-329-4701 to arrange transportation.
 Member Services will ask a series of questions to
determine the best transportation option
 Please contact us at least 72 hours before the
appointment
Social Health – How We Help
• Having the proper support through
family members, friends and the
community and living fulfilling lives
• Having a safe home and access to social
resources
 Safety in the Home
 Electricity
 Running Water
 Social Services
 Financial Assistance
 Housing
 Food Assistance
• Providing Resources
 Support Groups
 Advocacy Organizations
Helping Members Achieve THEIR Dreams
• Goal Setting
 Part of Care Plan
 Not just health goals, but life goals
• Goal Examples:






Following the treatment plan
Going back to school – GED/College
Remaining independent
Living in the community
Reaching their full potential
Employment
• How IlliniCare helps:
 Coaching, guiding, empowering
 Finding resources
 Assistance in navigating the system
Empowering Members
• PCP Selection
 Allowing members to choose their provider
• Involved in Care Plan Creation
 We involve member in every step of the process along with PCP and
community care team
 Member’s health and personal goals contribute to overall care plan
• Coordinating Transportation
 Giving member the freedom and power to travel to/from their appointments
• Connections Plus Program
 If qualified, give member access to cell phone to connect with IlliniCare,
Care Team, PCP and familial supports
• CentAccount Program
 Reward members for healthy behaviors
 Empower members to purchase health-related items with a pre-paid debit
card
What does Integrated Care Achieve?
• Care that is delivered at the right time, in the
right setting
• Improved Health Outcomes
• Access to Preventive Care
• Independent Living in the Community
Success Stories
“I want to write, here, how happy and pleased I am with
IlliniCare. I had to choose a new plan and I am so
grateful I chose yours.”
- Mary Y., in response to receiving the member newsletter
“I just wanted to take a quick minute and let
you know, as a marketer myself, how
refreshingly impressed I was. I wasn’t looking
forward to having to deal with an HMO for
one of our patients for PA, until I started
dealing with the employees. And one that
particularly stands out is Lisa Kimbrough –
but they are all great. Everybody’s very
efficient, they call you back, there’s no
attitude; it doesn’t drag out. Blue Cross
should hire your staff.”
- Sharon Ballor, Applewood Rehab, Marketing
& Admission Director
“It is good to know IlliniCare is so
dedicated to the health of its
members. Thank you as well for
assisting me with this housing
dilemma. As you (so rightly) said,
‘housing is a part of health.’”
-Veronica, after working with the
integrated care team
“He should get some sort of employee of the year
award just for taking care of my problems. I can’t
thank him enough for all the rigmarole he had gone
through on my behalf.”
- Debbie L., after working with the Integrated Care Team on
behalf of her daughter, an IlliniCare member.
“We really, really do appreciate the transportation service provided through
the IlliniCare Plan. You guys are way ahead of the competition. In fact, there is
no competition because other companies will be following you.”
- Katrina T., caregiver of IlliniCare member
Dental Success
Member Name: Derrick*
Stats: 23 years-old, male
Diagnosis: Autism, mental retardation and epilepsy
•
•
•
•
•
Derrick’s mother contacted ICT. he was experiencing
pain, fever and mouth swelling. She requested help from
the ICT.
Directed Derrick to his PCP to treat the infection;
member had a tooth abscess.
Unable to tolerate dental exam, needed IV sedation.
Next step was to treat the abscess. Worked with the
members preferred dental provider.
SCA put into place for the member’s preferred
anesthesiologist.
Terri, a program specialist with
IlliniCare worked with the member and
his mother to get him the care he needed.
• The entire process involved a collaboration of the Integrated Care Team, IlliniCare
management and contracting, providers, and the member's mother working together for the
optimal outcome for the member.
• The end result was the member received the necessary treatment on February 22nd.
*Members name changed to protect confidentiality
Encouragement is a part of health
Member Name: Angela*
Stats: 56 years-old, female
Diagnosis: Traumatic brain injury, multiple brain aneurisms, seizure disorder
•
Chris contacted Angela to complete the HRA. She was in need of DME, including
a shower bar and a C-PAP machine. Chris was able to refer her to the appropriate
providers to get what she needed.
• Angela did not like the PCP she was automatically assigned to, so Chris helped her
find a new PCP. She has been seeing her doctor regularly, and likes him a lot.
• Angela explained that she felt lonely; she has never met someone in her situation
before. Even when she spoke to others that have had an aneurism, she felt they
couldn’t understand her.
Chris, a program specialist,
• Chris encouraged Angela by explaining that she could help other people who are
helped a member with her
having a hard time recovering, since she’s been through two aneurisms. Chris gave
medical needs, as well as her
her the information for the Brain Injury Association of Illinois, so she could join a
emotional needs.
support group. She had never considered that perspective, and is contacting them
to join a support group.
• Angela is a great advocate for herself, so Chris also referred her to Equip for Equality.
• Chris is currently helping Angela work with the Department of Rehabilitation in order to get the services she
needs such as a homemaker and meals on wheels.
• Angela recently went to one of our members-only health events. At that event she raved about Chris, and how
much he was doing on her behalf.
*Members name changed to protect confidentiality