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Provider Meeting:
On-Demand Edition
February 2015
Agenda
The Medicaid Transformation
 My Care Alabama
 Partnering with My Care
 Our Contact Information

Slide 2
What’s changing in Alabama?
THE MEDICAID
TRANSFORMATION
Slide 3
The Legislation

Alabama Legislature passed Medicaid
reform legislation in May 2013 (amended
April 2014)
• Authorizes the development of Regional
Care Organizations (RCOs)
• Divided the State into 5 Regions
• Modifies payment structure from Fee-ForService to Capitated

The Medicaid Agency submitted an 1115
Waiver to CMS in May 2014 to approve
this model
• Approval pending, and expected October
2015
Slide 4
The RCO Model
The RCO must be
•
•
•
•
A Provider-owned, risk-bearing entity
Incorporated as a non-profit in Alabama
A service provider to Medicaid beneficiaries only
Responsible for full claims administration
The RCO Model should
• Address fragmentation in the State’s delivery system
• Improve beneficiary outcomes
• Support quality care and protect and further improve access to
health care providers
• Increase transparency and fairness in the Medicaid reimbursement
system
• Minimize disruption to current access to care
Slide 5
The RCO Responsibilities
RCO Responsibilities
•
•
•
•
•
•
Processes claims and pays Providers/Facilities
Contracts with Medicaid Providers/Facilities
Customer Service
Education
Care Management
Coordination of community resources
State Responsibilities
• Handles enrollment and assignment of recipients
• Handles provider enrollment into the Medicaid program
• Determines minimum benefit standards
Slide 6
RCO Covered Beneficiaries
Two-Thirds of the Medicaid
population will be enrolled in
RCOs starting October 2016.
Covered Aid Categories:
• Aged, Blind, & Disabled
• Breast & cervical cancer treatment
program
• Medicaid for Low Income Families
• SOBRA children and mothers
Projected Enrollment
Region A
Region B
Region C
Region D
Region E
Years 1-2
Years 3-5
120,000
221,000
61,500
172,000
108,000
130,000
240,000
69,000
188,000
116,000
Uncovered Aid Categories:
• Dual Eligibles
• Foster Children
• Hospice Patients
• ICF-MR Patients
• Nursing Home/ Institutional recipients
• Plan 1st recipients
• Home/community-based waiver
patients
Source:http://medicaid.alabama.gov/documents/2.0_Newsroom/2.7_Topics_Issues/2.7.3_RCOs/2.7.3.2_RCO_
Presentations/2.7.3.2_RCO_update_tuscaloosa_5-15-14.pdf
Slide 7
Current RCO Applicants
Region A
Alabama Community Care
(Huntsville Hospital/Sentara)
Region B
My Care Alabama (RCHP and HBS, LLC)
Alabama’s Care Plan
Alabama HealthCare Advantage North
Region C
Alabama Community Care, Region C
(Huntsville Hospital/ Sentara/ DCH)
Alabama HealthCare Advantage West
Region E
(UAB/St. Vincent’s)
Alabama HealthCare
Advantage East
Region D
Care Network of Alabama, Inc.
(East Alabama Medical Center/
Baptist Health Montgomery/
Southeast Alabama Medical Center)
Alabama Healthcare
Advantage, Inc.
Gulf Coast Regional Care Organization
(University of South Alabama)
Alabama HealthCare Advantage South
Slide 8
Applicants who received Probationary RCO status as of
12/29/14
Agency Timeline to Implement RCO
My Care is participating in the Health Home Program (formerly known as the PCN).
• PMP Contracts to participate in the Health Home are due 2/25.
Letters of Intent for the RCO Program are due by 3/15.
• We anticipate starting RCO contract negotiations late 3rd quarter of this year.
My Care anticipates
beginning RCO contract
negotiations with Providers
Slide 9
Who are we?
MY CARE ALABAMA
Slide 10
The Risk Partners
Eliza Coffee Memorial
Hospital
Florence, AL
GMS
Shoals Hospital
Muscle Shoals, AL
HBS is a wholly-owned
subsidiary of
Blue Cross Blue Shield
of Alabama.
Slide 11
My Care Alabama was formed in
the fall of 2014 for the sole
purpose of serving the Medicaid
recipients in North Alabama
RCHP is the parent
company of Eliza
Coffee and Shoals
Hospitals.
Our Team
Our
experienced
team of
Alabama-based
companies
ensures the
success of the
RCO and the
Health Home
programs
Slide 12
Our Vision
Slide 13

Provide innovative approaches
that remove barriers to healthcare
for the at-risk population in
Alabama

Increase quality and reduce costs
while improving the health of our
members

Utilize and grow Alabama-based
resources

Deliver a holistic, communitycentric solution to our members
Our Approach
Our primary focus is
the Medicaid
Member. We believe
that every Member
is one generation
away from being off
of Medicaid and
improving their lives.
But it will take a
holistic approach to
make that belief a
reality. Every entity
in this wheel is
required to make a
difference in our
Members’ lives.
Slide 14
Healthcare
Providers
Friends/
Family
Education
Food
Services
Members
Faith
Community
Services
Housing
Transportation
Citizens Advisory Board Members
Representing
Donna Jacobs
Alabama Arise
Executive Director, Victim Services of Cullman
Todd Steigerwald
Executive Director, Glenwood Autism and Behavioral Health
Center
Kathryn Strickland
Disabilities Leadership Coalition of
Alabama
Food Services
Executive Director, North Alabama Food Bank
Larry Pippins
Housing
Executive Director. Athens Housing Authority
Mary Ellen Judah
Community Services
Executive Director, Neighborhood Concepts
Daniel Kasambira
Higher Education
Director, Alabama A&M University Student Health & Wellness
Center
Kenneth Benefield
Ashley Day
Slide 15
Medicaid Members
Governing Board Members
Healthcare Business Solutions
Regional Care Hospital Partners, Inc.
Sherrie LeMier, President and COO
Rob Jay, EVP COO
Chere Wood, General Counsel
Stephen Page, Assoc General Counsel
Stacy Taylor, Executive Director
Monica Bowman, VP of Physician Services
Presley Rebman, Director of Operations
Herman Williams, Chief Medical Officer
Mark Sloan, Director of Networks
Russell Pigg, CEO, Eliza Coffee Hospital
David Brown, Director of Strategy
Jeff Jennings, CEO, Shoals Hospital
Alabama Optometric Association
Martha Morrow, OD
Alabama Pharmacy Association
Frances Cohenour, Pharm D
Shoals Chamber of Commerce
Charles Stewart, Manager, Southwire’s 12
For Life Program
FQHC
Dr. Larry Keith Scarborough
MASA
Christopher Coccia, D.O., Cullman Family Practice
Grant R. Allen, MD, FAAP
Citizen’s Advisory Committee
Todd Steigerwald, Chair
Donna Jacobs, Co-Chair
Slide 16
The Bottom Line
Slide 17
Why is My Care a great partner for you?
PARTNERING WITH MY CARE
Slide 18
How We Benefit You

Blue Cross Blue Shield of Alabama will be
processing claims and payments for My Care
Alabama
• We offer the same Administrative Excellence you
receive with other Blue Cross Blue Shield business
 95% of every dollar goes toward member car
 Commercial-level service claims administration
 Timely Payments

We offer Improved Reimbursement
• Profit sharing plan through quality incentives
Slide 19
How We Benefit Your Patients

We offer enhanced care management
• We will ensure patients get to appointments
• We will ensure patients follow care plan
• We provide non-traditional support through
our community partners
• Food
• Housing
• Faith-based
Slide 20
• Transportation
• Education
• Care Giver Support
We want you to be part of My Care

Contract with us for Health Home
• Submit Contracts by February 25, 2015
• PMPs only (Family Practitioner, General Practitioner,
Internist, Pediatrician, OB/GYN)

Contract with us for RCO
• Letter of Intent due March 15, 2015
• All Providers and Facilities

Share your knowledge
• Let us know if you are interested in being part of our
Provider Standards Group
Slide 21
Our Contact Information
Please don’t hesitate to call or email us with
any questions or concerns.
www.MyCareAlabama.org
Toll-free: 855-494-6335
[email protected]
Fax: (205) 402-9238
Slide 22