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State Health Insurance Assistance Program (SHIP)

State Health Insurance Assistance Program (SHIP). Rita Cairns, SHIP Director April 23, 2013. OVERVIEW. SHIP Grant Objectives Definitions Performance Measures Targets and Best Practices. Objective # 1.

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State Health Insurance Assistance Program (SHIP)

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  1. State Health Insurance Assistance Program (SHIP) Rita Cairns, SHIP Director April 23, 2013

  2. OVERVIEW • SHIP Grant Objectives • Definitions • Performance Measures • Targets and Best Practices Protecting and promoting the health and safety of the people of Wisconsin

  3. Objective # 1 • Provide personalized counseling to an increasing number and diversity of beneficiaries – including Medicare Part D, LIS, Medicare Advantage Plans, as well as other public and private insurance. • Emphasis on individuals with low income, disabled, dual with mental illness, limited English proficiency. Protecting and promoting the health and safety of the people of Wisconsin

  4. Objective # 2 • Targeted outreach to beneficiaries in public forums, with community-based partners, to increase understanding of Medicare benefits and to raise awareness of the opportunities for assistance with benefit plan selection. • Emphasis on enrollment events, events targeted to beneficiaries with income under 150% of FPL ($1,436), dual mentally ill. Protecting and promoting the health and safety of the people of Wisconsin

  5. Objective # 3 • Increase and enhance beneficiary access to counselors trained in providing the full range of services, including enrollment assistance in appropriate benefit plans and Part D coverage plans. • Emphasis on partnering with public and private organizations, on quality assurance to assure accuracy of information, training for staff and volunteers. Protecting and promoting the health and safety of the people of Wisconsin

  6. Objective # 4 • Participate in CMS education and communication activities, to assure that counselors are equipped to respond to program updates. • Emphasis on CMS Forum calls, National Medicare Training Program, SHIP Navigator newsletter, continued… Protecting and promoting the health and safety of the people of Wisconsin

  7. Objective # 4 • Train-the-Trainer Program, www.SHIPTalk.org website. • Updates on ACA, Preventive Services, DMEPOS, Fraud, Volunteer recruitment, training, retention and supervision. Protecting and promoting the health and safety of the people of Wisconsin

  8. Metro Slices • Groupings of similar counties within a state, from the more populated Large Central Metro Slice to the most rural counties - Outside Metro Slice. • In Wisconsin, there are six metro slices. Each is rated on each performance measure against similar slices nationwide (apple to apple comparison). Protecting and promoting the health and safety of the people of Wisconsin

  9. See Attachment # 2

  10. Attachment # 2, continued

  11. Wisconsin’s Metro Slices # of Medicare Beneficiaries • Large Central Metro (LCM) • Large Fringe Metro (LFM) • Medium Metro (MM) • Small Metro (SM) • Micropolitan (MIC) • Outside (OUT) TOTAL • 135,055 (14.4%) • 138,590 (15.1%) • 129,761 (14.1%) • 220,687 (23.7%) • 136,709 (14.6%) • 170,132 (18.1%) • 930934 (9/11/2012) Protecting and promoting the health and safety of the people of Wisconsin

  12. Performance Measures (PM) • PM 1 through PM 8 measure different quantitative data of the program. • All measures are weighted at 10%, except for PM1 = Client Contacts (20%), PM3 = Substantial, personal, direct client contacts and PM5 = LIS contacts (15%). Protecting and promoting the health and safety of the people of Wisconsin

  13. See Attachment # 1 – Performance Measures PM 1 through PM8 PM1 - Total client contacts per 1,000 Medicare beneficiaries in the State. (20% weight) PM2 - Persons reached or enrolled at specific public events per 1,000 Medicare beneficiaries in the State. (10% weight) PM3 - Substantial, personal, direct client contacts per 1,000 Medicare beneficiaries in the State. (15% weight) PM4 - Contacts with Medicare beneficiaries under age 65 in the CMS-defined Disabled program per 1,000 Medicare beneficiaries in the Disabled program. (10% weight) PM5 - Low-income Medicare beneficiary contacts and/or contacts that discussed low-income subsidy (LIS) per 1,000 low-income Medicare beneficiaries. (15% weight) PM6 - Contacts with one or more qualifying enrollment topics discussed per 1,000 Medicare beneficiaries. (10% weight) PM7 - Contacts with one or more qualifying Part D enrollment topics discussed per 1,000 Medicare beneficiaries. (10% weight) PM8 - Total number of counselor hours per 1,000 Medicare beneficiaries. (10% weight)

  14. Benchmarks • Based on yearly Minimum Attainment Thresholds (MAT) and Exemplary Benchmarks (EB), achieved by each slice nationally, on each of the 8 measures. Protecting and promoting the health and safety of the people of Wisconsin

  15. Minimum Attainment Threshold • MAT = midway point • 50% of the particular metro slices nationally perform above and 50% perform below the particular performance measure. ½ Midpoint (MAT) ½ Protecting and promoting the health and safety of the people of Wisconsin

  16. At or Above Exemplary Benchmark (EB) • Level of elevated performance in each of the 8 PM and each slice attained by the top performing states the prior year (typically the top 5 states or so). Protecting and promoting the health and safety of the people of Wisconsin

  17. Exemplary Benchmark, Between MAT and EB, MAT and Below MAT EB Between MAT and EB MAT - Midpoint Below MAT Protecting and promoting the health and safety of the people of Wisconsin

  18. See Attachment # 3 Protecting and promoting the health and safety of the people of Wisconsin

  19. Attainment vs. Improvement • Attainment = Range between the national MAT value to the EB value, per measure per slice – for the particular year. Protecting and promoting the health and safety of the people of Wisconsin

  20. Attainment Attainment • Is there an upward increase compared to the prior year’s MAT/EB range of each metro slice, in each PM, when compared to similar slices nationally? • If yes, depending on how much increase there is, Wisconsin would receive up to 10 points (being at EB would generate 10 points). Protecting and promoting the health and safety of the people of Wisconsin

  21. Attainment vs. Improvement • Improvement = Range between the state’s previous year’s performance and the national EB value, per measure, per slice, for the particular year. Protecting and promoting the health and safety of the people of Wisconsin

  22. Improvement Improvement • Is there improvement compared to our own baseline from last year in each PM in each slice? • If yes, depending on how much improvement there is, Wisconsin could receive up to 10 points. Protecting and promoting the health and safety of the people of Wisconsin

  23. Overall Performance Score (OPS) • Points from 1 to 10 that each State receives on each PM in each slice, based on the better of either the Attainment or the Improvement score. Protecting and promoting the health and safety of the people of Wisconsin

  24. Local Performance and MetroSlices • Wisconsin has roughly 14% - 18% of beneficiaries in each slice. The SM slice accounts for 23.7%. • Improvement in overall performance scores (OPS) in the more highly populated beneficiary slices would noticeably improve OPS. Protecting and promoting the health and safety of the people of Wisconsin

  25. Total Client Contacts Nationally Protecting and promoting the health and safety of the people of Wisconsin

  26. Targets for 2013 • See next slide as an illustration • EBS, see your own local agency’s PM information, titled: “Performance Measures by County for 12 Month Period Ending 30 December 2012” Protecting and promoting the health and safety of the people of Wisconsin

  27. Targets for 2013 • Column1 – slide 31 – or refer to your own county’s performance measures = Number of PM (1 through 8) • PM1 – Total client contacts per 1000 Medicare beneficiaries 20% Weight • Calculation based on 12 month period – (generally July 1 through June 30) Protecting and promoting the health and safety of the people of Wisconsin

  28. Targets for 2013 • Column 2Name of County • Column 3 Slice indicator • Column 4 Numerator (CC in 2011) • Column 5 Numerator (CC in 2012) Protecting and promoting the health and safety of the people of Wisconsin

  29. Targets for 2013 • Column6 Targetto MAT • Column 7 Between MAT and EB • Column 8 Target to EB • Column 9 Denominator (# of Medicare ben.) Protecting and promoting the health and safety of the people of Wisconsin

  30. Targets for 2013 • Column 10 PM Calculated Value 36.3 Numerator ÷ Denominator 686 ÷ 18,878 = .0363 .0363 x 1000 = 36.3 Protecting and promoting the health and safety of the people of Wisconsin

  31. Targets for 2013 • Column 11 MAT for slice • Column 12 EB for slice • Column 13 Status as of 12/30/2012 • Because this county is BELOW MAT, as of 6/30/2013 they should aim to be at MAT and have 1,135 CC between July 1, 2012 though June 30, 2013. Protecting and promoting the health and safety of the people of Wisconsin

  32. Strategies for ImprovingPM 1 Understanding the definition of Client Contact A client contact (CC) includes each contact between a counselor or staff, and Medicare beneficiaries, seniors, and their family members or continued… Protecting and promoting the health and safety of the people of Wisconsin

  33. Strategies for Improving PM 1 Continued… others (representatives) working on behalf of a client – and vice-versa. Contacts may be in-person in office or home visit, by phone – all durations, e-mail, letter, or fax. Protecting and promoting the health and safety of the people of Wisconsin

  34. Strategies for Improving PM 1 A single counselor can only submit one CC for the same client for the same day, even when there are multiple contacts by the same client on the same day. The original CC should be edited to add any additional time and any additional issue. Protecting and promoting the health and safety of the people of Wisconsin

  35. Strategies for Improving PM 1 Beneficiaries attending a Public and Media Activity - PAM (e.g. “Welcome to Medicare”) should not be counted as CC unless they receive individual assistance (such as assistance with enrollment). However, the total number of attendants should be reported in PAM. Protecting and promoting the health and safety of the people of Wisconsin

  36. Strategies for Improving PM 1 • If two or more separate counselors assist the same client on the same day, each counselor should complete a separate form for the contact. Protecting and promoting the health and safety of the people of Wisconsin

  37. Strategies for Improving PM 1 Example: Counselor Jane is assisting a client with an issue – and Jane has a question, so she asks Tom, a counselor in the same agency (or in another agency) for advice. Both Jane and Tom can claim a separate CC and the respective amount of time spent on the client’s issue(s). Protecting and promoting the health and safety of the people of Wisconsin

  38. Strategies for Improving PM 1 • Use the Performance Improvement Initiative Tracking Tool (Attachment # 4), in tandem with running NPR reports (CC and PAM), to keep tabs on your goals. • Set quarterly goals to achieve the numbers needed by June 2013 (EBS, see Performance Measures by County). Protecting and promoting the health and safety of the people of Wisconsin

  39. Strategies for Improving PM 1 • At one of your staff meetings, encourage everyone (I&A, DBS, etc.), to become registered SHIP counselors*, and report all Medicare or Medicaid related contacts. * SHIP Counselors must receive SHIP related trainings. Protecting and promoting the health and safety of the people of Wisconsin

  40. Strategies for Improving PM 1 • Make it convenient for them by providing a log sheet (see Brown County’s log sheet – Attachment # 5). • When explaining the log sheet, reference the CC hard copy. (Attachment # 6). Protecting and promoting the health and safety of the people of Wisconsin

  41. Strategies for Improving PM 1 • If you have a volunteer program, consider setting goals for volunteers revolving around the number of contacts they can make, rather than hours of service (more tangible). Protecting and promoting the health and safety of the people of Wisconsin

  42. Strategies for Improving PM 1 • Example: They can write a letter or make a phone call to remind each of last year’s AEP clients about what they need to complete if they plan to come in again for options counseling. Protecting and promoting the health and safety of the people of Wisconsin

  43. Strategies for Improving PM 1 • A few days later, follow up phone calls by sending materials to those who indicate that they will return for another session of options counseling (e.g., send them a template where they can list current plan and current medications and dosages). • The follow up can be counted as a new CC. Protecting and promoting the health and safety of the people of Wisconsin

  44. Strategies for Improving PM 1 • Time spent recruiting, training and supervising volunteers pays off in the end. • Start small (one or two volunteers). • Retired professionals make excellent volunteers (teachers, accountants, SSA personnel, EBS, DBS, I&A, ESS). • Have different ‘levels’ of volunteers. Protecting and promoting the health and safety of the people of Wisconsin

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