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Advisory Council October 2019 Meeting Presentation: Healthy Connections Prime

Monday, October 21, 2019

Printer Friendly Version in PDF Format (6 PDF pages)


Healthy Connections Prime:Caregiver Supports

Dustin K. Welch, MHA, PAHM

Healthy Connections Prime

  • South Carolina’s Initiative
    • Healthy Connections Prime Implemented: February 2015
    • Demographic: Medicare-Medicaid Enrollees 65 years and older
    • Available in 40 Counties
    • Medicare-Medicaid Plans (MMP):
      • Absolute Total Care
      • FirstChoice VIP Care Plus
      • Molina Healthcare
South Carolina State Map, by County: All counties have Healthy Connections Prime available, except for Aiden, York, Lancaster, Dorchester, Darlington and Horry.

National Integrated Care Initiative

Three ID cards: Medicare, Medicaid, and prescription drugs One ID card
Three different sets of benefits and payment streams Single set of benefits with a single payment stream
Poor communication among providers Coordinated communications, including discharge planning
Health care that is neither coordinated nor person-centered Person-centered care model featuring a multi-disciplinary team;
Incomplete knowledge of patient’s condition, medical records, medications and care plan Provider and care coordinator access to individualized care plan; medication reconciliation
Limited time, staff resources or incentives to coordinate services Model of care promotes and incentivizes coordination; value-based purchasing
Lack of appropriate incentives to provide care at the right time and in the least restrictive setting Rate structure and quality incentives address right time and right place for care

Waiver Authority

  • Demonstration Program
    • Section 1115A of the Social Security Act provides CMS the authority to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care furnished to individuals under such titles, including allowing states to test and evaluate fully integrating care for dual eligible individuals in the State.
    • South Carolina is one of 13 original states that implemented a Financial Alignment Demonstration program.


September 2019 Active Enrollment: 14,829 members, active in 40 counties
PIE CHART, Enrollment Percentage by Plan: Molina Dual Options 25%, Absolute Total Care 29%, First Choice VIP Care Plus 49%. PIE CHART, Enrollee Population Breakdown: Community 12,061, HCBS Waiver 2,504, Nursing Facility 264.
Source: Phoenix data as of September 2019

Program Design: Person-Centeredness

  • Comprehensive assessment
    • MMPs use uniform assessment tool
    • Conducted face-to-face, primarily in members’ homes
    • 94.5% completed within 90 days of enrollment*
    • Measures psychosocial, functional, behavioral health
    • Includes assessment of home and caregiver supports
    • Influences individualized care plan
    • Member to care coordinator ratio: 1:137
  • Multidisciplinary Team
    • Replaces ‘rules based’ care management
    • Addresses social determinants of health (i.e., housing, food insecurity, transportation)
CIRCLE DIAGRAM: Outer circle--Care Coordinator; Center circle--Member & Family; Circle Between--Pharmacy, Medical Transportation, HCBS, Family/Caregivers Support, Behavioral Health, Hospital, Nursing Facility, Doctors/Nurses.

Person-centeredness Design and Caregiver Supports

Person-centeredness focus includes four program design domains, all of which recognizes the support provided by family caregivers.

  • Assessment and Care Planning
    • Assessments include caregivers’ well-being and assesses depression, stress, and overall quality of life
    • First step of a member assessment is always cognitive assessment
  • Training
    • Dementia-capable training supports members and caregivers
    • Care coordinators undergo dementia-capable training, including a Dementia Dialogues certification program
  • Benefit Design
    • Program design includes palliative care, which can help relieve treatment burden for members and caregivers
    • In 2016, 49% of our members eligible for palliative care accessed the benefit
  • Quality Improvement
    • SC MMPs are required to conduct Quality Improvement Projects (QIPs) to address common problems that improve quality of life for members and caregivers (e.g., fall reduction kit.

Program Design: Support for Family Caregivers

  • Healthy Connections Prime recognized by AARP for its:
    • Caregiver assessment
    • Care coordinator training
    • Quality measurements related to caregiver supports (i.e., required caregiver focused Quality Improvement Project)
  • AARP
    • “The caregiver-as-provider role places them in a critical position to affect outcomes that matter to the managed care organization.”
  • South Carolina Caregivers
    • 700,000 caregivers in SC
    • Care is valued at over $7 billion
    • Caregivers arrange transportation, help with grocery, finances, meal prep, and housework

Support: N., & A. (2015). 2015 Report: Caregiving in the U.S. Retrieved June 5, 2017, from AARP. (2013). Long-Term Care in South Carolina. Retrieved June 5, 2017, from

Member Story

Our member has chronic kidney disease and Alzheimer's dementia. The Care Coordinator assisted the member and her caregiver in obtaining community support services and education in care for adults with mental health disorders. The Care Coordinator also assisted the family in creating a disaster plan before the October 2015 torrential rain and floods.

A member’s spouse (who was also her caregiver) suddenly passed away. Her Care Coordinator helped the family arrange adult day-care and home health service, and arranged for legal assistance to help create a Power of Attorney for medical and financial needs, grief counseling, home utility assistance and DME services. Family was very appreciative of the MMP’s assistance.

Alzheimer’s and Dementia Training

  • 10% of all Healthy Connections Prime members have a diagnosis of Alzheimer’s or related dementias (2016 Medicare claims data).
  • Alzheimer’s Association, South Carolina Chapter
    • Advanced Dementia Training Topics include:
      • Diagnosis, Prognosis, Treatment
      • Communication and Feelings
      • Intimacy and Sexuality
      • Wandering
      • Dementia and Driving
      • Staff and Family Support
      • Spiritual Care and End of Life Issues
      • Alzheimer’s Association Resources
  • University of South Carolina Office for the Study of Aging
    • Dementia Dialogues Certification Program
      • 5-part series, Continuing Education Units
    • Dementia Dialogues T.I.P.S.
      • Talking Points, Interventions, Problem Solving Strategies, and Solutions
    • Elder Abuse Identification and Reporting
      • Types of abuse, mandated reporting, Adult Protective Services
    • End-of-Life Care
      • Advanced Care Planning, Hospice, Palliative Care

For More Information