Lifemark Long Term Care Experience.ppt

Lifemark Long Term Care Experience December 15, 1999 The Lifemark Mission Through innovative care management services and technology offerings, Lifemark strives to create fundamental change in the well being of vulnerable, frail, elderly and chronically ill people. Locations Phoenix, AZ (Corporate Office) Albuquerque, NM Fort Smith, AR Honolulu, HI Houston, TX Indianapolis, IN Lansing, MI San Diego, CA LIFEMARK CORPORATION Care Management Strategies for “At Risk” Populations December 1999 Care Manager Scope of Authorization LTC Services/Placements include Nursing Facility Assisted Living/Personal Care Home/Adult Foster Care Adult Day Care Community based alternatives Medical Supplies/DME Value Added Services Home Services Personal, Attendant, and Chore Services Skilled Home Health Care/Short term therapy Emergency Response Systems Meals on Wheels Respite Arizona/Texas LTC Program(s) State Medicaid Agency Retains Responsibility For: Determining Member Program Eligibility (Both Financial and Medical) Health Plan Assignment HCFA Waiver/State Regulations Program Compliance Monitoring/Auditing RFP Development, Scoring and Awards Aging Population Longer Life Expectancies Prevalence of Chronic Conditions Complex Benefit Coordination Why is Long Term Care (LTC) a heightened issue? The Coordinated Model Integrated Services Long Term Care Home and Community Based Services Behavioral Health Medical Care Services: Inpatient/Outpatient care Physician Lab/Radiology EPSDT Transportation Ancillary Services Specialist Pharmacy DME Therapies “Single Entity” LTC HCBS Behavioral Health Medical Care Svcs Coordinated Medicare fee-for-service and/or Medicare HMO Benefits Coordinated LTC Model Full Continuum of Placement Options Most Restrictive Least Restrictive Assisted Living/ Residential Care Adult Foster Care Home Adult Care Home Home or Apartment Specialty Unit within a nursing facility Skilled Nursing Facility Patient Centered CareCase Manager’s Role Nur