CONNETICUT MEDICAID MANAGED CARE

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Connecticut Department of Social Services
HUSKY Transition Brief Overview/Update
January 9, 2009
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Voluntary transition began 9/08

• Voluntary transition of HUSKY member households
  began Sept. 1, 2008, from departing Anthem
  BlueCare Family Plan and Traditional Medicaid.
• States 3 contracted health plans receiving
  members Aetna Better Health AmeriChoice by
  United Healthcare Community Health Network of
  CT.

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Over 106,000 members have switched

• To date, households representing nearly 86,000
  HUSKY A members have voluntarily left Anthem BCFP
  
• Households representing more than 20,300 HUSKY A
  members have voluntarily left Traditional
  Medicaid.
• 93,000 enrollees who were already in Community
  Health Network in September 2008 were not
  affected by the transition.

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Key points Migration fromAnthem, Medicaid

• Most households voluntarily switching so far have
  chosen incumbent health plan Community Health
  Network of CT, which has long-time provider
  network in place. Enrollment in CNHCT has grown
  from about 93,000 to about 158,000.
• Provider networks in new health plans Aetna
  Better Health AmeriChoice by United Healthcare
  have made significant gains and continue to
  develop.

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Next Steps Transition nears completion

• State of Connecticut and federal government have
  approved the process to move forward.
• U.S. Centers for Medicare Medicaid Services has
  approved Connecticuts managed care contracts
  with Aetna Better Health, AmeriChoice by United
  Healthcare Community Health Network of CT.
• CMS has authorized mandatory enrollment. This
  will take effect Feb. 1, 2009, for households in
  Anthem BCFP Traditional Medicaid that have not
  chosen new plan by Jan. 30.

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Next Steps Member notice process

• Approximately 56,900 HUSKY A member households
  were mailed notices at the end of December.
  These were the households in Anthem BCFP and
  Traditional Medicaid that had not chosen a new
  plan by that time.
• HUSKY B note 4,475 households of HUSKY B
  member children in Anthem BCFP were also sent
  notices. By 1/6/07, the number of HUSKY B Anthem
  households had dropped to 3,170.
• Since the notices were mailed, several thousand
  members have changed plans. The number of
  individuals self-selecting one of the 3 managed
  care plans is increasing daily.
• DSS is scheduling a second notice that will
  remind remaining Anthem BCFP and Traditional
  Medicaid members about changing plans by January
  30.

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Migration from Anthem BlueCare Family Plan
Traditional Medicaid by the numbers
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Summary Transition almost complete

• Of the total HUSKY A population of about 153,000
  households, the number still in Anthem and
  Traditional Medicaid at the end of December 2008
  was about 56,900. 
• This number drops incrementally each day as
  families pick new plans. Consequently, the
  number of families subject to having DSS pick a
  new plan for them because they have not done so
  by the end of January will be considerably lower
  than the 56,900 receiving notices at the end of
  December.
• Customer service support is in place to mitigate
  any problems for families changing plans.  This
  includes the long-time 2-1-1/HUSKY Infoline
  service, which also will make outbound calls to
  families over the month. Customer service points
  at health plan membership services and ACS (HUSKY
  enrollment center) also assisting.

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Capacity

• Formulas are based on pre managed care ratios of
  providers to members
• And utilization of services by members of various
  categories of PCPs
• The three PCP groupings used for capacity are
• Adult
• Children
• Women

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Capacity

• Adult providers include
• Family practitioners, general practitioners,
  internists, and NPs and PAs working in those
  areas
• Child providers include
• Family practitioners, general practitioners,
  internists, pediatricians, and NPs and PAs
  working in those areas
• Women providers include
• OB-GYN, Nurse Midwife, and NPs and PAs working in
  those areas

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Capacity

• General practitioners, family practitioners,
  internists, and NPs and PAs who work in these
  areas are split between adult and childrens
  capacity
• i.e. One family practitioner .67
• providers for adult capacity
• and .33 providers for children

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Capacity

• Ratio of PCP to total members enrolled
• Adult providers 1 to 387
• Children providers 1 to 301
• Women providers 1 to 835

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HUSKY Enrollment Capacity
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Charter Oak Enrollment Capacity
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Specialists by Plan HUSKY
Includes Dermatology, Gastroenterology,
Geriatrics, Infectious Disease, Neurosurgery,
Podiatry, Pulmonary Disease, Rheumatology,
Thoracic Surgery, Urology, Vascular Surgery, Other
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Specialists by Plan Charter Oak
Includes Dermatology, Gastroenterology,
Geriatrics, Infectious Disease, Neurosurgery,
Podiatry, Pulmonary Disease, Rheumatology,
Thoracic Surgery, Urology, Vascular Surgery, Other
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Plan Assignments

• Members who do not choose a plan by 1/30 will be
  assigned into one of the two new plans.
• This is done to develop sufficient critical mass
  in the two new MCOs more quickly to ensure
  viability, and
• So as to not overwhelm CHN administratively.
• Automatic plan assignment will occur up to 85 of
  a new plans capacity. If that should occur, CHN
  will then begin receiving default enrollments
  again.
• Arizona, Delaware, Illinois, and New Mexico also
  did this for their new plans when they
  re-procured their contracts

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Transition Care Coordination

• MCO Medical Directors input was solicited as to
  what data should be sought from the prior plan
  for transitioning members
• Bimonthly data exchanges include information for
  members who
• Are in case management, including pregnancy
• Are in disease management
• Are inpatient
• Have existing prior authorizations
• Members transitioning from TM to a plan receive
  data for members who
• Pregnant
• Receiving home health care
• Have a recent inpatient stay

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Transition Care Coordination, continued

• In addition, all plans will routinely be
  receiving dental, behavioral health and pharmacy
  activity data of their members.
• Protocols for referrals between the plans, and
  the Behavioral Health Partnership and Benecare
  are in place.
• The Behavioral Health Partnership and the plans
  refer members requiring co-management (medical
  and behavioral health services) to each other.

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Coordination for HUSKY members with prescheduled
ongoing trips (e.g. dialysis, therapy)

• Members switching from Anthem to Aetna or
  AmeriChoice
• will continue to receive NEMT from LogistiCare
• Anthem members switching to CHNCT      
• Logisticare is passing prescheduled trip
  information to CTS, CHNCTs NEMT vendor
• TM clients switching to the MCOs
• Logisticare will continue to provider services
  for those in their service area that switch to
  Aetna or AmeriChoice
• Arrangements are being made with FirstTransit to
  transfer info to LogisitCare or CTS   

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PCCM Pilot Areas

• Waterbury 4 practices, including
• 16 Pediatricians
• 8 Internal Medicine physicians
• 6 Internal Medicine / Pediatric physicians
• 7 Nurse Practitioners (family, children, and
  obstetrics)
• 1 Certified Nurse Midwife
• 4 Physician Assistants included in these
  practices
• Mansfield/Windham 3 practices, including
• 5 Pediatricians
• 2 Family Medicine physicians
• 4 Nurse Practitioners (for adults and families)

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PCCM Member Mailings

• Member mailings are being sent to households of
  existing patients of participating PCPs
• Waterbury area 6,153 households
• Mansfield/Windham area 2,229 households
• Mailing to include January 30, 2009 date of
  deadline for BCFP and TM member switch
• No deadline for PCCM enrollment for targeted
  households
• Remind members of available customer service
• Remind members of ongoing ability to change
  between plans or PCCM (No Lock-in)

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PCCM Provider Advisory Group

• First meeting was Tuesday, January 6
• Included providers from the pilot areas and
  applicants from other areas
• Regular meetings to occur
• Subcommittees include
• Care coordination
• Disease management
• Program evaluation

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