Caresource Ohio Inc

Programs: Caresource, a leading nonprofit managed care organization based in dayton, ohio, has been living its mission to make a lasting difference in our members' lives by improving their health and well-being for more than 27 years. Caresource serves more than 1,320,000 million medicaid members in ohio. Caresource's membership includes: (1) medicaid consumers, including families with low income, children, pregnant women, those who are aged, blind or disabled, and those who are eligible for home and community based services through execution of an annual provider agreement with the ohio department of medicaid (odm), (2) dually eligible consumers for medicare and medicaid through ohio's dual demonstration program, mycare, (3) medicare advantage consumers, (4) a qualified health plan offered through the federal health insurance marketplace, providing low-cost comprehensive coverage for individuals and families, and (5) community transition program consumers who are transitioning from the ohio department of rehabilitation and correction back to the community through a grant from the ohio department of mental health and addiction services. Caresource program services: 1) caresource ohio medicaid: caresource pioneered ohio's first mandatory medicaid managed care program in 1989, and is now one of the largest medicaid managed care plans in the country. Caresource's years of experience in managing medicaid managed care programs and member-focused approach to care have allowed caresource the opportunity to forge strong, positive regulatory relationships with state agencies, including departments of insurance. Caresource has earned over 54% of the statewide managed care market share, with the highest voluntary enrollment rate and the lowest voluntary disenrollment rate of all ohio participating medicaid managed care plans. Caresource focuses on prevention with a goal of improving member health, the quality of health care services received, and accessibility of health care services for medicaid members. This is done through an innovative health and wellness methodology. Caresource has a broad, statewide network of more than 39,000 providers, including primary care and specialist physicians, hospitals, nursing facilities, home health care agencies and other medical providers who provide medical services as well as assist in the coordination of member care for caresources members. Caresource offers 24-hour nurse call center services staffed by registered nurses, to help members access appropriate care and divert unnecessary emergency department visits. Caresource's commitment to quality is demonstrated through the organization's national committee for quality assurance (ncqa) accreditation. Caresource is accredited for the medicaid health plan by ncqa. Accreditation demonstrates caresource's commitment to quality and enhances caresource's ability to improve the health and well-being of those we serve. To further drive quality and achieve caresource's health outcomes targets, caresource incentivizes certain providers through a value based incentive model. Caresource focuses efforts on creating incentives and reimbursement options to support our models that recognize quality at the provider level. Caresource created a program that provides additional incentives to providers for delivering quality based services that impact healthcare effectiveness data and information set (hedis) measures. Caresource created a shared savings model that rewards the provider for attaining quality targets while sharing savings. In this particular model, caresource established "filters" such that the provider had to meet or exceed quality metrics before being eligible to share in cost savings. Value-based incentive models ultimately result in improved member health outcomes as providers continue to deliver quality service with the member's health and safety at the forefront. Caresource's community-based care coordination program serves members who have the greatest need for care coordination services. Members receive enhanced care coordination services based on their complex physical, behavioral and social health needs. Caresource's community-based team of nurses, social workers and community health workers, helps members navigate the complex and often-confusing medical and social service systems. Caresource collaborates with community partners and providers such as the area agencies on aging, community mental health centers, local pharmacies, and federally qualified health centers to ensure members receive the services they need. 2) caresource mycare ohio: caresource also participates in the mycare program as part of ohio's dual demonstration program. Caresource entered into a three-way contract with odm and the centers for medicare and medicaid services (cms) to serve members who are dually eligible for both medicare and medicaid. By integrating medicare and medicaid services, caresource is helping ohioans achieve better health outcomes, thereby reducing unnecessary or redundant costs from fragmented health systems. Through mycare, caresource members receive person-centered care coordination that coordinates their physical, behavioral, long-term care, and social needs. 3) caresource medicare advantage: through a contract with the ohio department of medicaid, caresource manages members in the columbus, cleveland, and marietta regions of ohio who are eligible for the home and community based services (hcbs) waiver, also known as the ohio home care waiver. Through this program, caresource provides in-home and community-based care coordination services that help individuals remain at home instead of residing in a nursing home or other long-term care facility. 4) caresource marketplace: caresources qualified health plan on the health insurance marketplace is an important part of the organization's mission to serve the uninsured and offers affordable coverage to those who qualify through low premiums, copayments and deductibles. 5) caresource community transition program: caresource services members through the community transition program (ctp), which works with individuals returning from ohio state prisons who have received substance use disorder treatment while incarcerated. The program provides pre-release planning and linkage to community based providers to improve the reentry experience. Also, members have access to treatment and recovery services to improve successful reintegration, including housing, transportation, peer support, employment services and other supportive reentry services. Caresource was chosen through a competitive rfp process by the ohio department of mental health and addiction services to be the state-wide administrator of the community transition program. Caresource enhanced member benefits: caresource provides enhanced benefits to members that are above and beyond required benefits defined by state or federal agencies. Together, these enhanced benefits provide caresource members additional program benefits in order to make a lasting difference in our members' lives by improving their health and well-being. In 2016, caresource paid over $60 million to fund these enhanced benefits, including the following: (1) transportation, $30,577,000 (2) rx (pharmacy) co-pay, $13,138,000 (3) dental, $1,622,000 (4) non-emergent er co-pay, $2,218,000 (5) vision exams and vision hardware, $360,000 (6) outcomes mtm, $10,506,000 (7) babies first, $526,000 (8) silver sneakers, $295,000 (9) member assistance fund, $206,000 (10) life services, $1,382,000 (1) transportation: in order to ensure members are able to access the most appropriate medical care, caresource provides transportation services for office visits to their medical provider's office, ensuring that members are keeping preventive, sick or follow-up appointments. (2), (3), (4), & (5): pharmacy, dental & vision, non-emergent er co-pays : ensuring that our most vulnerable members receive needed care, caresource does not charge medicaid members a copayment for pharmacy products, dental visits, vision examinations, vision hardware or non-emergent emergency department visits, even though the regulations allow for such copayments. (6) outcomes mtm: caresource has partnered with outcomes mtm to deliver a medication therapy management (mtm) program. The program provides focused mtm services, including face-to-face member visits with pharmacy staff. Pharmacists provide complete medication reviews to help members with their medications. By providing this service, the organization has decreased unnecessary hospitalizations and emergency department visits. Caresource is one of only a few medicaid plans to voluntarily provide this service to its members. (7) babies first: caresource is dedicated to motivating our pregnant members to seek prenatal and postpartum care through caresource's babies first member incentive program. Moms-to-be can receive reward cards for attending regular ob/gyn appointments while pregnant and