Communities Without Barriers

1. Communities Without Barriers Coordinating Effective Care for Dual Eligibles

2. Welcome and Introduction • Aaron Crowell, VP Business Development • 17 years business and consulting experience

3. Alaina Maciá, President & CEO • Ten year MTM veteran • Implemented & led more than ten statewide & regional non-emergency medical transportation (NEMT) programs • Spearheading MTM’s expansion into new product opportunities • Member of Washington University’s Institute for Public Health National Council

4. Changing Healthcare Landscape • Healthcare reform • Focus on Home & Community Based Service (HCBS) coordination for dual eligible populations • Keeping members out of long-term care institutions and in their homes • $36,000 vs. $9,000 annual average Based on 2008 national enrollment data

5. Simulating the Village Lifestyle • Advancements have had unintended negative effects • Back to basics solutions • MTM’s HCBS model simulates the village atmosphere • Coordinated communities of HCBS providers partner with a Care Coordinator • Facilitates services that members need to stay in their homes safely & happily

6. About MTM • Established in 1995 to manage NEMT benefit for Medicaid & Medicare members • Contract with credentialed local transportation providers • Supported by Customer Service, Claims, Quality & Care Management departments • 18 years of experience improving health outcomes • URAC accredited • MO-certified WBE; IN & IL-certified affiliate

7. Business spans 28 states Seven million trips managed annually Three and a half million members served every year Five customer service centers take in three million annual calls National Footprint

8. Evolving with Our Clients • As healthcare evolves, MTM evolves with it to meet clients’ needs • Acts as an integral part of member care plans • Expanding to new service offerings • Ambulance authorizations & claims adjudication • Call center education & outreach • HCBS

9. Leveraging HCBS to Support Members • HCBS provides services that aging, ill & disabled populations need for a healthy, happy & social lifestyle • Meals • Home care • Home modifications • Home cleaning • Transportation • Companionship • A community-based social life

10. Utilizing Quality Service Providers • HCBS provider networks are readily available but unmanaged & uncoordinated • MTM’s model ensures cost effectiveness & quality • Network development staff • Credentialing & training • Uniforms & badges • Audits & satisfaction surveys

11. Supporting Your Case Managers • Care Coordinator acts as an extension of your team

12. Supporting Your Case Managers • Care Coordinator connection leaves your Case Managers free to focus on clinical care • Simulates the village approach • Ensures quality services are provided in a timely manner • Reminds members & caregivers about appointments • Acts as a liaison between all involved parties • Schedules & coordinates social activities

13. Coordination Process • Case Manager requests in-home OASIS assessment • Care plan developed in coordination with Case Manager & medical provider • Care Coordinator authorizes & arranges HCBS • Services are provided • Payment for service authorized

14. Leveraging Technology • State-of-the-art technology streamlines services • Prior authorization & claims processing software • Vendor management software • Eligibility & encounter data processing systems • Web-based vendor portals • Smart phone apps

15. Coordinated Care Case Study • Patient: Margaret Smith • 78-year-old female • Chronic kidney disease & diabetes • Dual eligible beneficiary • Hospitalized for broken hip & later discharged from a rehabilitation facility • 86-year-old husband is primary caretaker

16. Mrs. Smith’s Needs • DME (walker) • Home modifications to ensure access • RN to manage medication • Home Health Aid for bathing & light housekeeping • Meal preparation/service for 60 days • Transportation to medical appointments & social activities

17. Coordinating Care for Mrs. Smith • Care Coordinator augments care plan with social activities & transportation resources • Call Mrs. Smith for upcoming appointments, routine check ins & follow up on meals, medication, etc. • Oversight & management of HCBS providers • Real-time communication with feedback loop to Case Manager • Report outcomes & important milestones

18. Benefits of Care Coordination Model • Improved continuity of care • Reduced service & communication fragmentation • Significant cost avoidance • Improved health outcomes

19. Proven Care Coordination Results • Studies show coordination reduces healthcare costs • University of Colorado Health Sciences Center • Conducted in 28 states • Nearly 158,000 participants • 22% to 26% decline in hospitalizations • 5% to 7% improvement in health outcomes

20. Closing • Questions? • Contact MTM to learn more about how we can partner to address gaps in HCBS delivery as you expand into new markets • Free assessment of your organization’s needs

21. MTM is about improving members’ overall health & wellbeing by providing services to promote independence & remove barriers to healthcare while reducing costs to clients.