Jeffrey Katz, MD, ACEP Physicians’ Housecalls HBPC Practitioner View/No Disclosures ©AAHCM

 Dual Eligible patients mostly found at home  Medicaid MCO members wander: ◦ Medicaid Neighborhoods ◦ Do not prioritize health issues or provider encounter ◦ free government cell phones, ◦ relatives and friends addresses, ◦ cold calls, ER, pharmacy, hospital addresses ©AAHCM

 Find common ground, talk up not down  Demonstrate trust with follow up and follow through  Address changes in address and phone number each visit ©AAHCM

 What diagnosis contributed to last ER/Hosp admission and what were triggers?  Did social/home chaos contribute to non-compliance/lack of focus?  Did untreated psychiatric/substance abuse contribute to non compliance? ©AAHCM

 Utilize Case Managers and Social Services for transportation, Meals on Wheels, PCA  Speak to other prior community providers including methadone/subox providers  Access to Regional Health Information Exchanges (“RHIOs” – CRISP in Maryland/DC),  Curaspan, Patient 360 ©AAHCM

 Medicaid MCO members medically sicker and on steeper decline slope  Diabetes, COPD, CHF, HIV, Hep. C,  Bipolar, Schizophrenia, Major Depression,  GSW paraplegia, Wounds  Coordinate Care or fail ©AAHCM

 All MCO’s focus on cost containment so ER/Hospital utilization, specialists, skilled RN, etc.  Network and build relationships in your community, at hospital fundraisers, state medical society meetings, where-ever possible  Know your worth and articulate what you can do for the MCO to contribute to cost containment and care  MCO will pay 100% ( not 80%), on time, and a premium for accurately valued/priced services, but  Be ready to be graded on performance. ©AAHCM

 Ask for 6 month trial to demonstrate impact on cost reduction, care management,  All MCO’s rank members by relative illness burden, ER/admission risk, then group in manageability and severity groups.  Reference Academy or Scientific studies if no practice data specific to you ©AAHCM

 Build relationship with MCO Operations department  Ask for; ◦ ER/Inpatient PMPM costs, ◦ Run Rate and ◦ VBP completion rate as a historical method to track impact and practice improvement, (use 6 month intervals for review) ©AAHCM

 Price your services with your costs and your competition in mind  MCO’s will value one stop shop to avoid members enrolling in multiple programs  Transitional Care programs and ACO’s as emerging opportunities  Be ready for all Patients with all possible diagnoses, and,  From all Payers, patients may not be homebound, just ◦ frequently admitted and/or ◦ may not have existing PCP relationship. ©AAHCM