Serving Persons with Disabilities in Medicaid Managed Care

Sally Venator, CEO; Heartland Health Plan of Oklahoma

The Study...

“Serving the Special Program/Aged, Blind and Disabled Population through Managed Care Programs”

Four part study including:

• Member survey
• Provider survey
• Focus groups
• Cost effectiveness

Background (D-link)

Who was studied, what was studied, and when was it studied?

And the results are...

Trends in Reported Health Status (D-link)

% reporting "good" or "better health"

Overall, How Satisfied are you with HHPO's Managed Care Services (D-link)

MCO vs. FFS Satisfaction (D-link)

Provider Satisfaction with HHPO (D-link)

What do Surveyed Advocates Say about HHPO

• Wider range of services available
• Accountability has improved
• Navigation through the system is easier
• Exceptional Needs Coordinators’ (ENC) guidance is an improvement; it allows for a connection with someone who can assist

What do Advocates Suggest

• Continued education and training for providers and personnel related specifically to special needs of the SP/ABD member
• Home health access
• Respite care and other family resources are not as accessible as they need to be

It Must Cost More... Right (D-link)

More Services, Similar Cost (D-link)

* Excluding the 10 costliest enrollees

And the Verdict is...

• Analysis of claims data showed savings of approximately 15% by being enrolled in HHPO
• As shown through the focus group and the member and provider surveys, access, continuity of care and perception of health status improved in HHPO

What's the Secret

• Outreach, training, education and strong provider partnerships
• Allowing specialists to function as PCPs where more efficient and effective
• ENCs ENCs ENCs… and more ENCs
• ENC + Concurrent Review + Pre Authorization = effective care with manageable cost

Go to: Final Summary | Disability Conference | Provider Reimbursement | HRSA | HHS