San Diego Housing Federation Conference October 13, 2016 San Diego Housing Federation Conference Nora Faine, MD MPH Medical Director, Molina Healthcare

Role of Healthcare What: 5 percent—accounts for nearly half of total spending on health care, while 20 percent accounts for four-fifths of total spending. This relatively small slice of the population incurs such high costs because most of these individuals have complex medical problems Problems include common but difficult-to-manage chronic diseases like diabetes and heart failure, mental and behavioral health issues Prevention of readmissions to acute care hospitals and psychiatric hospitals repeatedly could save millions if hospitals, doctors, and community health programs worked together to connect wraparound services Better Care at Lower Cost: Is It Possible?, The Commonwealth Fund, November 2013.

Role of Healthcare How: Have reliable policies and procedures to communicate with other clinicians, agencies, service providers etc. with access to community and social support resources Coordination of care across settings to integrate services that are centered on the comprehensive needs of the individual Coordination at transitions of care e.g. discharged patients need clear instructions on how to care for themselves at home, as well as help in scheduling and keeping follow-up appointments, sticking to a prescribed medication plan, and making necessary lifestyle changes Effective strategies to end homelessness taking into account the individual’s health conditions and disability All of these have the potential to decrease healthcare cost, decrease societal cost and most importantly increase the quality of life of impacted individuals

Healthcare Systems / SDHC 360 View Person Healthcare Systems / SDHC Social Services HHSA / Housing EMS / Paramedics Health Plans 211

We strive to be an exemplary organization: Molina Healthcare - Who We Are In 1980, the late Dr. C. David Molina, founded Molina Healthcare with a single clinic and a commitment to provide quality healthcare to those most in need and least able to afford it. This commitment to providing access to quality care continues to be our mission today, just as it has been for the last 30 years. Mission Statement Our mission is to provide quality health services to financially vulnerable families and individuals covered by government programs Vision Statement Molina Healthcare is an innovative national health care leader, providing quality care and accessible services in an efficient and caring manner Core Values We strive to be an exemplary organization: We care about the people we serve and advocate on their behalf We provide quality service and remove barriers to health services We are health care innovators and embrace change quickly We respect each other and value ethical business practices We are careful in the management of our financial resources and serve as prudent stewards of the public’s funds This is the Molina Way

Molina Health Care San Diego Enrollment Medi-Cal 212,700 Medicare and Duals 13,033 Marketplace 7,672 ~2200 members in Complex Care Management ~300 members in monitoring Care Management

Molina Healthcare Services Complex Case Managers Community Connectors Transitions of Care Coaches Care Review Clinicians Pharmacists Behavioral Health Care Management Quality Management

Molina Healthcare Services Level 4 Imminent Risk Level 3 Complex CM Level 2 Case Management Level 1 Health Management Level 4 Imminent Risk Level 3 Complex CM Level 2 Case Management Level 1 Health Management

Molina Healthcare Services Care management is the core of the Molina model of care Member centered and individualized Offered based on risk assessment Supported by an Interdisciplinary Care Team (ICT) Guided by an integrated plan of care Assures member receives all necessary covered benefits Occurs across settings of care: home, hospital, skilled or custodial nursing facility as well as transitions between care setting Includes: Family, caregiver, support system Functional, cognitive and behavioral health status and needs Cultural & linguistic needs

Interdisciplinary Care Team (ICT) Purpose Assess needs, contribute to care plan, problem solve based on subject matter expertise, assure timely access to needed services and care Core ICT Member or Member’s representative, Primary physician Case Manager Additional Members (as needed) Family/caregiver, nursing home staff, specialty providers, behavioral health provider, etc. Goal Develop an Individualized Care Plan

Individualized Care Plan Based on the results of the assessment and consultation with members of the Interdisciplinary Team Includes coordination of medical and ancillary services, including but not limited to medical, long term services and supports (LTSS), behavioral health, substance use disorders, and social services Reviewed on a quarterly basis, or more frequently if there is a change in condition or critical event.

Molina Healthcare Services Transitions of Care Coaches Engage members in the hospital with bedside visits Facilitate pending discharges by contacting the assigned Molina Care Review Clinician RN Assist with PCP or Specialist follow up appointments Arrange transportation Facilitate medication refills Educate member on their diagnosis, treatment options, and medications Provide community resources as needed Remain engaged for 30 days post discharge

Molina Healthcare Services Behavioral Health Care Management Personal Service Coordinator (Medicare) Link member to medical, behavioral health and other resources Keep member independent in their home, decrease ED use Quality Management Monitor quality of services Receive and track reports of sentinel events Goal to build on current processes and work with providers to continually improve processes Focus on quality measurements and data collection

Other Related Services Cultural & Linguistic Services Reduce barriers to accessing quality healthcare Interpreter / Translation Services Provider Services Network adequacy and integrity Provider training, tools and inquiries

Collaborative Opportunities Leverage capabilities and assets Decrease duplication of services Increase effectiveness Prevent unanticipated denials / delays Create a collaborative approach to determine an individual’s appropriate level of care Achieve seamless care coordination

Healthcare Systems / SDHC 360 View Person Healthcare Systems / SDHC Social Services HHSA / Housing EMS / Paramedics Health Plans 211 Right Care Right Place Right Time Right Coordination

Q & A