Integrated Care Organization for Medicare-Medicaid Dual Eligibles NAMI – Saturday, October 20, 2012

page 2 Blue Care Partnership of Massachusetts About | Why are we doing this? The current state of care for dual eligible adults has been characterized as:  Lacking coordination between Medicare and Medicaid  Fragmented and unmanaged  Not person-centered  Lacking services for care coordination and community-based alternatives

page 3 Blue Care Partnership of Massachusetts About | Blue Care Partnership Blue Care Partnership’s goals are designed to:  Improve quality, costs, and independent living  Eliminate barriers to care  Guarantee person-centered, coordinated care  Increase access to the right services in the right locations  Simplify administrative processes  Achieve cost savings through improved coordination

page 4 Blue Care Partnership of Massachusetts About | Blue Care Partnership – Why We Came Together  Largest Massachusetts not-for-profit health plan, serves over 2M consumers  Statewide network of 21,000 primary care physicians, specialists, acute care hospitals  Medicare plans since 1966: Medicare Advantage, Medex® supplemental plans, Blue MedicareRx (Medicare Part D) prescription drug plans  Rated among the nation's best health plans for member satisfaction and quality  75 years of community partnerships  Comprehensive behavioral health services for 430,000 MassHealth Enrollees (Primary Care Clinician Plan)  Support services to Primary Care Clinicians serving MassHealth Enrollees  Parent company ValueOptions® serves 32M+ consumers. Services include: mental and emotional wellbeing, recovery and resilience, employee assistance, and wellness  Strong community involvement. Presence across MA since 1996

page 5 Blue Care Partnership of Massachusetts About | Power of the Partnership A Member Engagement Strategy that meets members where they are and designed to place members at the center of care planning Community-based Care Coordinators, lay Health Educators, Peer Counselors, and Community Health Workers meeting face-to-face to members Regular member outreach and education “No wrong door” referral policy and process Member-driven care plan Culturally and linguistically appropriate A Community Engagement Strategy that partners with community supports such as CSP providers, peer run organizations, churches, schools, universities, and local governments to provide education, training, research and outreach. A Provider Engagement Strategy that recognizes and values providers as key members of the care plan team. Multi-disciplinary Care Team and Care Plan Increased Provider Flexibility

page 6 Blue Care Partnership of Massachusetts About | Power of the Partnership Consumer & Family Council  Blue Care Partnership is committed to consumer involvement at all levels of the organization  We believe the care management, services, supports and other assistance that is provided by BCP must be provided in a manner that demonstrates respect for individual dignity, personal preferences, and cultural differences.  We believe that people with disabilities and/or lived experience have expertise that is critical to the development of our policies, programs and services as well as to the solution of problems.  BCP will create a Consumer & Family Council and hire a full time disability outreach coordinator

page 7 Blue Care Partnership of Massachusetts About | Model of Care – How does it work?

page 8 Blue Care Partnership of Massachusetts About | BCP – Additional Services Diversionary Behavioral Health Services  Community Crisis Stabilization  Community Support Program (CSP)  Partial Hospitalization  Acute Treatment Services for Substance Abuse  Community Support Program for Substance Abuse  Psychiatric Day Treatment  Intensive Outpatient Program  Structured Outpatient Addiction Program  Program of Assertive Community Treatment  Emergency Services Program

page 9 Blue Care Partnership of Massachusetts About | BCP – Additional Services New Community-based Services (Flexible Services that may be included in the Individualized Care Plan)  Day Services  Home Care Services  Respite Care  Peer Support/Counseling/Navigation  Care Transitions Assistance (across settings)  Home Modifications  Community Health Workers  Medication Management  Non-Medical Transportation Expanded Services  Preventive, Restorative, and Emergency Oral Health (Dental) Benefits  Personal Care Assistance (including cueing and monitoring)  Durable Medical Equipment (training in usage, repairs, modifications)  Environmental Aids and Assistive/Adaptive Technology  Vision Services

page 10 Blue Care Partnership of Massachusetts About | How BCP Can Help – Example Problem:23-year old woman diagnosed with an eating disorder and obsessive compulsive disorder symptoms Receiving inpatient and/or acute residential treatment for very lengthy stays (averaging 50 days) eight different times over a three-year period Her living situation contributed to her symptoms and her poor self-care, which led to medical deterioration and psychiatric crises Solution: Care team focused on coordination among multiple medical and behavioral health providers, case conferences with facilities and practitioners caring for her, securing consults with a dietician, and supporting her and her family with Long Term Services and supports Result:She was successful in stabilizing her weight, engaging with a new outpatient team, moving into her own apartment, re-engaging in full-time employment, and remaining in the community

page 11 Blue Care Partnership of Massachusetts About | How BCP Can Help – Example Problem:56-year old man was diagnosed with lung cancer and congestive heart failure. He lived alone and was experiencing increased anxiety and depression. He had a friend that he relied on for transportation who was ill and no longer able to assist him with his care. Solution:His care coordinator assisted him with securing outpatient counseling to deal with the depression and anxiety. A Community Support worker assisted with coordinating transportation and requested a social work evaluation from the VNA to assist with long-term planning and coping. Additional resources were identified to assist with further transportation needs, compliance with medication, and keeping medical appointments. Results: After a history of multiple acute hospitalizations, he has remained in the community.

page 12 Blue Care Partnership of Massachusetts Contact Audrey Shelto Chief Executive Officer Blue Care Partnership Blue Cross Blue Shield of Massachusetts 401 Park Drive Boston, MA Nancy Lane, PhD Chief Executive Officer Massachusetts Behavioral Health Partnership 100 High Street 3rd Floor Boston, MA Thank you!