1. MLTSS Riding the Tidal Wave of Change
A Consumer Perspective on
Community HealthChoices
Roll Out in SW Pennsylvania
October 3, 2018

2. Today’s Session Who we are and our perspective
The Community HealthChoices Southwestern PA Roll Out
Who is included
Communications
Service Coordination – Community and Nursing Facilities
Person Centered Planning
Service Delivery – PAS, Transportation, Home Modifications
Specialized Populations – Brain Injury
The Role of PHLP
What We Learned / Improvements
Riding The Tidal Waive of Change
October 3, 2018

3. The Perspective We Bring
TRPIL
XtraGlobex
Centers for Independent Living are a resource for participants
Commitment to the success of Community Health Choices
Developing strong partnerships with the Managed Care Organizations
Pushing the bar, don’t be afraid to ask questions
Supporting participant's through the process
Strategic Consultants Grounded in Consumer Advocacy
Focus on Quality and Readiness
Committed to Providers Succeeding in New Environment
Actively Facilitating Communications and Consumer Needs
Proactively Bringing Providers Together
Riding The Tidal Waive of Change
October 3, 2018

4. Community HealthChoices Roll Out
SWPA - Over 82,000 Participants Enrolled
Stable Enrollment at End of Continuity of Care period
Regional Dominance of UPMC
Rebalancing Efforts In Focus by MCO’s
Better Execution in PAS than other Services
Continuing Challenges in Transportation, Home Modifications, and Special Populations
Consumer Confusion about Medicaid / Medicare Coordination
SE Roll Out Communications Started
Riding The Tidal Waive of Change
October 3, 2018

5. Communication Multiple channels were used to get the message out
Issues with communication and how they worked through
How the State continues to address issues
CHANNELS TO GET COMMUNICATION OUT:
Informational Flyers sent out to participants informing them of the changes
Community Meetings
Aging Well Presentations
Notices mailed out to participants with specifics
Pre enrollment packets
Post – enrollment packets
B. Communication with the participants started later than it should have. The state has addressed this issue started communication with the roll out of phase two earlier.
C. Participants were overwhelmed with the documents related to choosing a provider.
D. Many participants did not receive provider choice documents.
E. The enrollment website was not launched prior to the auto assignment date.
F. The telephone helpline for enrollment had serious customer service issues.
Riding The Tidal Waive of Change
October 3, 2018

6. Consumer Experience: Lauren
MAWD recipient, employed full time
Uses agency model daily, supports at home and work
Has experienced significant stress during rollout
Currently has no copy of her service plan or authorization
Finds most recent changes to be intrusive
Riding The Tidal Waive of Change
October 3, 2018

7. Service Coordination
Objectives of Service Coordination in Community Health Choices
Administrative function in Pennsylvania controlled by the Managed Care Organizations
Needs Assessment Process
Appropriate service delivery
Coordination of Medicare; Behavioral Health Services and Medicaid
Coordination with Non-Medicaid Services
Service Coordination Network Consolidation
The primary objective of service coordination in CHC was to oversee the person-centered service planning process and to provide support for CHC program participants, targeting participants with um met needs.
EXAMPLE: Pest eradiation; unmet housing needs
ISSUES:
Many service coordination entities were not adequately informed to support participants in understanding choice.
Providers fell ill prepared to provide services
Communication about the role of service coordination beyond the continuity of care period has been very unclear and stressful for participants.
D. State solicits input but responses are inconsistent.
Riding The Tidal Waive of Change
October 3, 2018

8. Person Centered Planning Process
Person Centered Planning Process is Essential Success Factor
Consumer Active Engagement
MCO’s / SC’s
Providers and Informal Supports
Inconsistent Implementation by MCO’s and SC’s
Consumer ties the support they need to specific goals
Consumers Understanding of Array of Services Now Available – Broad Perspective versus Specific Historical Services
Community Participation and Rebalancing
Example: Needed supports- Transportation and PAS-Outcome
“My DCW will meet me at the pool to support my participation in aquatic exercise class”
Outcome: Greater social connection and increased wellness
Riding The Tidal Waive of Change
October 3, 2018

9. Role of the Pennsylvania Health Law Project
Independent / Unique to Pennsylvania
Monitor Implementation / PCPP
Establish observation process for new assessments to provide feedback to OLTL
Resource for grievance and appeal process
Stakeholders Advisory Group
Provide Legal support to individuals as needed
Riding The Tidal Waive of Change
October 3, 2018

10. Consumer Experience: Keith
Long time advocate for and user of consumer employer model PAS
Very unhappy about moving from OBRA to CHC
Has had difficulty with service coordination changes
Fears new policies will inhibit his community activity
Riding The Tidal Waive of Change
October 3, 2018

11. Service Delivery Personal Assistance Services
Consumer Directed Model
Agency Model
Transportation – MATP and EMATP
Home Modifications
Riding The Tidal Waive of Change
October 3, 2018

12. Electronic Visit Verification (EVV)
Required by Federal Law to Address Issues of Fraud and Abuse
Streamlines Timesheet Processing / Payroll
In PA, Intertwined with Authorization, Scheduling and Billing Processes (HHAX)
Consumer Concerns About Privacy and Flexibility
Direct Worker Concerns
Challenging Implementation and Transition for Providers of PAS
Riding The Tidal Waive of Change
October 3, 2018

13. Special Populations / Needs
Brain Injury Services
Cognitive Difficulties
Consumer / CLE Engagement
Person Centered Planning
Specialized Therapies
Nursing Facility Participants
Access to Transition Information and Supports
Housing
Community Integration / Transportation
Riding The Tidal Waive of Change
October 3, 2018

14. Where are we now? Many hiccups-
Program design had all the right elements, just not working as expected
Work to establish a rate that enables providers to better meet participants needs
Attempts have been made to cut existing plans, communication with the plan is imperative
Payments are slow
Riding The Tidal Waive of Change
October 3, 2018

15. How We Are Working to Improve Things
Communication channels between participants, MCO’s and the stat
Community listening sessions
Informal peer support
Provider Networks Evolving Around Quality
Provider Awareness and Readiness
Engagement in Measurement of Timely and Quality Delivery of Services
Revenue and Payment Cycles
Well established communication channels between the state and providers/advocates are in place/ weekly calls / provider networks
Community listening sessions have provided a form for consumers to voice concerns
Provider Networks
In the Rural Southwest, there is a robust network of informal peer support being formed to help consumers navigate their individual issues
Riding The Tidal Waive of Change
October 3, 2018

16. Questions? Contact Us: Fady Sahhar : fadysahhar@xtraglobex.com
Andrea Costello:
Brenda Dare:
Riding The Tidal Waive of Change
October 3, 2018