SNBC Learnings: Delivering Integrated Mental and Physical Health Support

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SNBC Learnings Delivering Integrated Mental and
Physical Health Support

• Jane Welter-Nolan, MS, LP Medica Behavioral
  Health
• Sarah Keenan, RN Medica

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Special Needs Basic Care(SNBC)

• Integrated Special Needs Plan
• Began 1.1.08
• Eligibility
• 18-64
• Certified disabled
• Medicare and Medicaid/or Medicaid only
• Benefits
• Medicare
• Medicaid
• Add ons
• Fitness Program
• Care Coordination
• (waiver and PCA remain fee for service)

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AccessAbility Solution

• Medicas brand name for SNBC
• Care System model
• Medica Care System
• AXIS Healthcare
• Medica Behavioral Health (MBH)
• Enrollment as of August, 2009
• 820

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AccessAbility Solution Care Model
Member submits enrollment information to Medica
Pre-enrollment assessment call is made to assign
member to care system Members may also choose
Care System
Member has behavioral disabilities (statewide)
Member has physical or developmental disabilities
(greater Minnesota)
Member has physical or developmental disabilities
(metro area)
Medica Care Coordination
MBH Care Coordination
Axis Healthcare Care Coordination
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Goals of SNBC

• Integrate medical and mental health care
• Assisting members in accessing comprehensive care
  across settings
• Coordinating between providers
• Improve preventative care

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Barriers

• Locating healthcare providers
• Scheduling appointments
• Transportation
• Difficulty tracking visits and follow up care
• Difficulty adhering to MD orders and/or plan of
  care.
• Frequent no shows for appointments

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Mental Health Care Coordinator Learning Curve

• MH Care Coordinators had to become familiar with
  accessing medical care, supplies and services.
• home care services
• durable Medical Equipment
• Medications-Part D formularies
• Ancillary services
• Dental
• Vision
• Medical Benefits
• IRTS

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Medical Care Coordinator Learning Curve

• Medical Care Coordinators had to become familiar
  with mental health services and how to navigate
  the mental health system.
• Mental health resources
• Locating mental health providers
• ARMHS
• ACT
• TCM
• Substance Abuse
• Safety Issues
• Self harm behaviors

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Tools for Care Coordination

• Assessment
• Developed Collaboratively
• Identifies medical, Mental health, social
  concerns
• Whole person approach
• Care Plan
• Address all identified needs
• Preventative Health
• Performance Improvement Projects

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Mental health and medical CCs collaboration

• Resource Partners
• Assist in navigating medical and mental health
  systems.
• Consult Process
• Evolved from co-care coordination to episodic
  consultation.
• Telephonic or face to face with recommendations'.
  
• Learning-
• Confirmed importance of single point of contact
  for mental health population
• Option to transfer case

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Case Studies-Mental health member

• 58 year old female on disability for mental
  health, homeless for 20 years but had housing at
  the time of enrollment. Presented in initial call
  as guarded and mistrustful of others. Presenting
  issue of needing transportation to medical visit
  but anxious about trusting someone.
• CC spent most of initial call establishing
  rapport with the member and at the end of the
  call offered assistance with transportation.
  Member was not ready to accept help yet, but did
  take CCs call back number.
• A few days later member called in asking for help
  with transportation and accepted help getting a
  ride set up. This was very significant because
  she had not asked for help in nearly 20 years.
• A few days later the member called in asking for
  assistance with seeing an eye doctor for glasses
  and a few weeks after that called in wondering
  where she could get a flu shot. A few months
  later the member called in asking for an
  appointment with a PCP to quit smoking and get a
  physical, the first she could remember in many
  years.
• Learning from this case
• Build rapport first
• Meet member where they are at
• Offer resources and options without telling the
  member what they need to do.

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Case Study-medical member

• 39 yo female in greater MN, physical disability,
  manual w/c in disrepair, PCA, dissatisfied with
  PCP, catheter supplies.
• CC obtained new w/c, supply vendor, new PCP
• Hx of depression. CC worked with resource partner
  at MBH to locate the right counseling services
  with positive results.
• Outcomes-
• Decreased ER visits
• Decreased UTIs
• Increased quality of life-self reported.

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How AccessAbility will work with Counties

• Protocols for communication with Case Managers
  including DHS communication form for Homecare
  services.
• Information sharing and coordination of service
  plans-with member consent.
• Option for telephonic care conferences.
• Medica AccessAbility Solution will continue to
  evaluate level of county involvement as the
  product progresses.

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Opportunities

• Mental Health Targeted Case Management
• Preferred Integrated Network
• Partnership with Dakota County
• Clinic without walls

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Contacts

• Sarah Keenan, RN
• Medica
• Director of Care Coordination Products and
  Special Needs Plans
• 952-992-2041
• Sarah.Keenan_at_medica.com
• Jane Welter Nolan, MS, LP
• Medica Behavioral Health
• Clinical Program Manager
• 1-800-548-6549 ext. 65275
• Jane.Welter-nolan_at_optumhealth.com

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Thank You for Your Time and Attention
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