Overview
For the elderly population and those under 65 years of age who have a permanent disability, Medicare has long been a primary means of health coverage. In 2005, about 4.9 million Medicare beneficiaries enrolled in Medicare Advantage Plans, and that number is continuously growing. Medicare Advantage Plans face the major challenge of controlling costs while delivering effective, quality care for this population. Managing over 800,000 Medicare lives during the past 10 years, CompCare has developed the most effective services for Medicare members.
By providing recovery-oriented programs built around effective care management and coordination between medical and behavioral services, CompCare has emerged as a leader in providing high quality care. CompCare operates two clinical tracts; one to address the behavioral health needs associated with the elderly through an integrated treatment approach and the other a very different and intensive program for the under 65, dual eligible population, designed to intervene with major mental illness and co-occurring medical problems. More than 50% of this population suffers from a behavioral illness in conjunction with other chronic illnesses.
Managed Behavioral Health
CompCare offers high-quality behavioral health management for your Medicare Advantage plan members. Clinicians are available via a toll-free hotline 24 hours a day, 7 days a week to assist members with accessing treatment and with setting up appointments. Our provider network is comprised of over 8,000 qualified specialists, including board-certified geriatric practitioners. Our providers are available to see members in a timely fashion and many of our psychiatrists are available to provide consultation in nursing homes and inpatient settings within 4 hours of the request.
CompCare's behavioral health services are built upon customized components and financed as full risk or ASO services. The service components that make up behavioral health management, including High Risk Care Management and Specialized Disease Management, can be unbundled to fit your Medicare Advantage Plan needs.
Key Elements
With Medicare spending concentrated among high risk beneficiaries, CompCare understands that paying attention to detail pays off for members and health plans. CompCare focuses on the details through Integrated Health Care Management, Behavioral Pharmacy Management and Compliance. These programs and services are designed to provide an integrated approach to care, so that the whole person is treated. Addressing these issues in an integrated fashion offers optimal results in both improved member outcomes and in cost-savings.
Integrated Health Care Management
CompCare significantly impacts medical and behavioral health outcomes through strategic interventions such as education, outreach, and targeted intensive care management both telephonically and through contact in the home or a public setting. To support Medicare members in complying with ambulatory treatment, CompCare's Integrated Health Care Management program offers several tiered steps to ensure the best possible outcomes for those identified as high risk, or who are identified as having co-morbid or multiple chronic conditions.
The Impact of Care Management Interventions
CompCare's Care Management interventions show impact in both savings and improved member outcomes. The decrease in number of inpatient days per member, during and after the program, resulted in a cost savings of $10,131 per member enrolled in the program.
In addition, when comparing the pre-enrollment and post-enrollment scores (as measured by the SF-12), the program shows significant improvements in members' behavioral health status as well as their physical health outcomes.
Behavioral Pharmacy Management
CompCare's Behavioral Pharmacy Management Product addresses the lack of coordination that often occurs when multiple physicians prescribe medications to a member and neglect to communicate with each other. The product also addresses the frequent prescription of medications outside of recommended guidelines. CompCare's Behavioral Pharmacy Product is designed to alleviate these common problems, improve treatment quality, and thereby reduce costs. The program is designed to:
Address high-risk practices in behavioral medicine
Improve overall quality and appropriateness of prescribing practices for patient care
Better integrate medical and behavioral treatment among multiple providers
Behavioral Pharmacy Management (BPM) provides CompCare with the opportunity to prioritize members with high needs that would otherwise be unknown to the payor. Integrated Health Care Management (IHCM) provides disease management services to those members who are high risk for health care based on pharmacy data analysis. Tiered intervention strategies focus on documented clinical outcomes and financial savings through integration of behavioral and medical interventions. The financial impact of BPM and IHCM is savings of 35% or more of the trend for increased behavioral pharmacy cost of outlier claims identified by Quality Indicators as part of a free Opportunity Analysis.
Compliance
Maintaining an effective compliance program is essential to providing a high quality program for Medicare Advantage members. Understanding and adhering to the Center for Medicare and Medicaid Services (CMS) guidelines and other federal and state regulatory agencies results in more efficient, cost-effective operations and prevents unnecessary and costly fines that may be incurred due to non-compliance. To this end, CompCare has successfully completed both CMS audits and Medicare health plan audits as part of managing Medicare lives since 1993. As a result, we fully understand the components necessary to ensure a successful Medicare program. In addition, for over five years, CompCare has maintained Full Accreditation from the National Committee for Quality Assurance (NCQA).
Substance Abuse Disease Management
CompCare's programs are centered on an integrated approach to care. Our belief is that effective, quality care stems from addressing medical, behavioral, and social issues. The "whole" individual is treated. Integration eliminates fragmented treatment, improves patient outcomes and minimizes costs that can occur as a result of wasteful overlaps or gaps in care. An integrated medical and behavioral approach is the foundation of our substance abuse disease management program. By combining cutting edge medical intervention with biopsychosocial supports and managed care technology, we offer a fully integrated treatment approach that optimizes outcomes. Specialized outreach telephonic or in person, crisis intervention, and same day appointments when needed provide the necessary support to ensure all barriers to care are eliminated. Transportation, medical care, housing, respite care, food, and prescriptions are all addressed to ensure a fully successful treatment process. In addition, multidisciplinary teams coordinate to provide support, referrals and treatment planning based on the individual's needs.
For more information, contact the Marketing Department at
813-288-4808 x4516.
Copyright © 2004-2006 Comprehensive Behavioral Care, Inc. (CompCare)
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