Communities Without Barriers Coordinating Effective Care for Dual Eligibles We will begin the webinar a few minutes after the hour to allow people to join.

Welcome & Introduction  Alaina Maciá, President & CEO  Ten year MTM veteran  Implemented & led more than ten statewide & regional non-emergency medical transportation (NEMT) programs  Spearheading MTM’s expansion into new product opportunities  Member of Washington University’s Institute for Public Health National Council

Changing Healthcare Landscape  Healthcare reform  Focus on Home & Community Based Service (HCBS) coordination for dual eligible populations  Keeping members out of long-term care institutions and in their homes  $36,000 vs. $9,000 annual average Dual Eligible 9 million members Medicaid 51 million members Medicare 37 million members Based on 2008 national enrollment data

Simulating the Village Lifestyle  Advancements have had unintended negative effects  Back to basics solutions  MTM’s HCBS model simulates the village atmosphere  Coordinated communities of HCBS providers partner with a Care Coordinator  Facilitates services that members need to stay in their homes safely & happily

About MTM  Established in 1995 to manage NEMT benefit for Medicaid & Medicare members  Contract with credentialed local transportation providers  Supported by Customer Service, Claims, Quality & Care Management departments  18 years of experience improving health outcomes  URAC accredited  MO-certified WBE; IN & IL-certified affiliate

National Footprint  Business spans 28 states  Seven million trips managed annually  Three and a half million members served every year  Five customer service centers take in three million annual calls

Evolving with Our Clients  As healthcare evolves, MTM evolves with it to meet clients’ needs  Acts as an integral part of member care plans  Expanding to new service offerings  Ambulance authorizations & claims adjudication  Call center education & outreach  HCBS

Leveraging HCBS to Support Members  HCBS provides services that aging, ill & disabled populations need for a healthy, happy & social lifestyle  Meals  Home care  Home modifications  Home cleaning  Transportation  Companionship  A community-based social life

Utilizing Quality Service Providers  HCBS provider networks are readily available but unmanaged & uncoordinated  MTM’s model ensures cost effectiveness & quality  Network development staff  Credentialing & training  Uniforms & badges  Audits & satisfaction surveys

Supporting Your Case Managers  Care Coordinator acts as an extension of your team

Supporting Your Case Managers  Care Coordinator connection leaves your Case Managers free to focus on clinical care  Simulates the village approach  Ensures quality services are provided in a timely manner  Reminds members & caregivers about appointments  Acts as a liaison between all involved parties  Schedules & coordinates social activities

Coordination Process  Case Manager requests in-home OASIS assessment  Care plan developed in coordination with Case Manager & medical provider  Care Coordinator authorizes & arranges HCBS  Services are provided  Payment for service authorized

Leveraging Technology  State-of-the-art technology streamlines services  Prior authorization & claims processing software  Vendor management software  Eligibility & encounter data processing systems  Web-based vendor portals  Smart phone apps

Coordinated Care Case Study  Patient: Margaret Smith  78-year-old female  Chronic kidney disease & diabetes  Dual eligible beneficiary  Hospitalized for broken hip & later discharged from a rehabilitation facility  86-year-old husband is primary caretaker

Mrs. Smith’s Needs  DME (walker)  Home modifications to ensure access  RN to manage medication  Home Health Aid for bathing & light housekeeping  Meal preparation/service for 60 days  Transportation to medical appointments & social activities

Coordinating Care for Mrs. Smith  Care Coordinator augments care plan with social activities & transportation resources  Call Mrs. Smith for upcoming appointments, routine check ins & follow up on meals, medication, etc.  Oversight & management of HCBS providers  Real-time communication with feedback loop to Case Manager  Report outcomes & important milestones

Benefits of Care Coordination Model  Improved continuity of care  Reduced service & communication fragmentation  Significant cost avoidance  Improved health outcomes

Proven Care Coordination Results  Studies show coordination reduces healthcare costs  University of Colorado Health Sciences Center  Conducted in 28 states  Nearly 158,000 participants  22% to 26% decline in hospitalizations  5% to 7% improvement in health outcomes

Closing  Questions?  Contact MTM to learn more about how we can partner to address gaps in HCBS delivery as you expand into new markets  Free assessment of your organization’s needs

MTM is about improving members’ overall health & wellbeing by providing services to promote independence & remove barriers to healthcare while reducing costs to clients.