Content by Keyword: Pharmacy

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APPENDIX A. STATE PROFILE TABLES

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. Appendix A. State Profile Tables

TABLE A.1 . Louisiana Program Characteristics Program Name Louisiana Behavioral Health Partnership (LBHP)
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E. Covered Populations and Services

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. E. Covered Populations and Services

Enrollment process . There is no formal enrollment process for patients; rather, PCPs enroll into Blueprint. All types of PCPs are eligible to enroll, but they must meet NCQA standards to be recognized as a PCMH and receive quality incentive payments. Vermont recognizes multiple provider specialties as PCPs, including internal medicine, general m
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D. Program Financing and Contracting

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. D. Program Financing and Contracting

Funding mechanism . TennCare operates under a Section 1115(a) demonstration waiver from CMS. The current demonstration, TennCare II, has been in existence since 2002 and expires in June 2013. The state has requested a three-year extension for the program under Section 1115(e). When TennCare II was last extended, in 2010, the extension included se
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B. State Context

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. B. State Context

TennCare aims to "demonstrate that the state can use managed care principles to serve Medicaid enrollees, as well as some individuals who are not Medicaid-eligible, without compromising quality of care and without spending more than the State would have spent had it continued its fee-for-service program" (Bureau of TennCare 2012b, 5). In 1996, beh
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I. Successes and Challenges

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. I. Successes and Challenges

Program successes . Over its history, CCNC notes a number of accomplishments. First, the program has achieved widespread engagement of PCPs; currently, 90 percent of primary care services are delivered to Medicaid beneficiaries via CCNC-affiliated primary care medical homes. In addition, CCNC has successfully built upon the existing health care i
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E. Covered Populations and Services

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. E. Covered Populations and Services

Covered populations . All North Carolina Medicaid recipients with full benefits--including full dual eligible--are eligible to enroll in CCNC, with the exception of nursing home residents. As of March 2013, 1.3 million Medicaid recipients were enrolled in CCNC--over 75 percent of the state's Medicaid recipients. Therefore the demographic and othe
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F. Quality Monitoring and Incentives

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. F. Quality Monitoring and Incentives

LBHP developed a comprehensive quality strategy to guide the measurement and oversight of the program (see DHH 2012b). The quality strategy describes specific goals, measures, and reporting processes. OBH and Magellan are collecting a wealth of information that can be used to examine trends in the utilization, quality, and outcomes of services. He
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E. Covered Populations and Services

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. E. Covered Populations and Services

Populations . Magellan manages behavioral health services for adults enrolled in Medicaid (including those dually eligible for Medicare) and for non-Medicaid adults eligible for OBH services. OBH projected that 164,360 non-disabled adults and 133,050 disabled adults would be eligible for 1915(b) services under the Magellan contract in the second
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Strategies for Integrating and Coordinating Care

Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States

This report describes the different strategies that four states--Louisiana, North Carolina, Tennessee and Vermont--are utilizing to improve the integration and coordination of care for individuals with mental health and substance use disorders. These strategies include introducing new managed care arrangements and care coordination mechanisms, enh
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E. Employment Interventions for Workers with

Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities. E. Employment Interventions for Workers with Serious Mental Illness At-Risk of Job Loss

In this section, we summarize findings on the current state of knowledge on interventions to improve employment outcomes among workers with mental illness at risk of job loss. Following a framework established by Nieuwenhuijsen et al. (2008) and Krupa (2007), our review divides interventions into two main groups: individual or worker level interve
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Thomson Medstat Medical Episode Grouper System

Understanding the High Prevalence of Low-Prevalence Chronic Disease Combinations: Databases and Methods for Research. Thomson Medstat Medical Episode Grouper System

Thomson Medstat Medical Episode Grouper References: 1 Thomson - Medstat. Medstat Disease Staging Software Version 5.24. http://www.hcup-us.ahrq.gov/db/nation/nis/DiseaseStagingV5_25ReferenceGu...
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Utah Department of Health Dataset

Understanding the High Prevalence of Low-Prevalence Chronic Disease Combinations: Databases and Methods for Research. Utah Department of Health Dataset

Utah All Payer Claims Database References: Office of Health Care Statistics Utah Health Data Committee. The Utah All Payer Claims Database (APCD). 2013. http://health.utah.gov/hda/apd/
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Centers for Medicare & Medicaid Services

Understanding the High Prevalence of Low-Prevalence Chronic Disease Combinations: Databases and Methods for Research. Centers for Medicare & Medicaid Services Datasets

CMS Chronic Conditions Warehouse References: Chronic Conditions Data Warehouse. 2013. https://www.ccwdata.org/web/guest/home
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Study Designs and Analytic Methods

Understanding the High Prevalence of Low-Prevalence Chronic Disease Combinations: Databases and Methods for Research. Study Designs and Analytic Methods

As discussed above, most studies examine chronic conditions with the highest prevalence, costs, utilization, hospitalizations, and adverse events. For example, to study chronic disease prevalence in male Medicare patients, Black and colleagues limited their analyses to the “top ten” most prevalent diseases (Black et al., 2007). Other researche
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NOTES

Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. Notes

PSH is a phenomenon of the 1990s and 2000s, when homelessness assistance systems evolved and their goals shifted and changed. PSH beds available to end people's homelessness went from about zero in the late 1980s to estimates of 114,000 beds in fall 1996 (Burt et al. 1999), about 188,000 beds in January 2007, and 284,298 beds in January 2013 (H
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7.4. Together4Health

Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 7.4. Together4Health

T4H is an example of an Accountable Care Organization-like entity under development.
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7.3. Hennepin Health

Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 7.3. Hennepin Health

In Minnesota, a 2010 state law authorized the Department of Human Services to develop a Medicaid demonstration project to test alternative and innovative health care delivery systems, including Accountable Care Organizations. That year a state law also authorized Hennepin County to establish a pilot program to provide a health delivery network for
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6.5. Medicaid Financing Issues for Managed Care

Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 6.5. Medicaid Financing Issues for Managed Care Organizations and Providers

"Full-risk" managed care plans receive funding on the basis of capitation, meaning that the plans are paid a set amount per-member per-month and expected to cover all care needed by their members. Capitation payments may be adjusted based on a variety of factors, including geography (reflecting regional cost variations within a state), characteris
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6.4. Care Coordination Through Managed Care

Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 6.4. Care Coordination Through Managed Care Organizations

Managed care plans must either deliver care coordination services to their members or contract with other organizations to do so. By care coordination, we mean the health assessment and care management needed by people to address multiple behavioral and physical health needs. This section describes some of the challenges that managed care plans ha
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4.4. Sustaining and Expanding Innovative Programs

Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 4.4. Sustaining and Expanding Innovative Programs: Addressing Challenges for Health Centers and Their Partners

As part of this case study project, we visited many Health Centers, including some that began as Health Care for the Homeless programs. Among the Health Centers that have been most engaged in serving people experiencing chronic homelessness and delivering services in PSH, innovative programs and integrated services have often been launched with su

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Form Approved OMB# 0990-0379 Exp. Date 9/30/2020