Cook County Public Health & Human Services (PHHS) is one of many counties across the state that contracts with managed care companies to provide Care Coordination for persons with disabilities and individuals age 65 and older. Cook County PHHS currently contracts with BlueCross BlueShield, HealthPartners, and UCare to provide Care Coordination services to roughly 75 residents of Cook County.
Managed care plans available in Cook County:
Minnesota Senior Health Options (MSHO) is a health plan for individuals ages 65 and older who have both Medicare Part A and Part B and medical assistance. MSHO offers the same benefits as Medicare and medical assistance do on their own and combines them into one package, which allows members to have one insurance card for all of their health care needs, including prescription drug coverage. There is no monthly premium for this plan; however, members may pay a co-pay for certain health care services.
Minnesota Senior Care Plus (MSC+) is a health plan for individuals age 65 and older who qualify for medical assistance. MSC+ does not include a recipient’s Medicare and prescription drug benefits into one plan. There is no monthly premium for this plan; however, members may pay a copay for certain health care services.
Special Needs Basic Care (SNBC) is a voluntary managed care program for individuals who are certified blind or disabled by the Social Security Administration or State Medical Review Team (SMRT), age 18-64 and enrolled in medical assistance. There are no co-pays for MA-covered services, prescriptions and over-the-counter drugs and there are no health plan premiums, deductibles or co-pays.
Benefits and services of managed care plans
Eligible recipients receive a variety of benefits and services through managed care plans, which may include the following:
Care coordination (which includes activities that help people to access and coordinate services) includes dental care, doctor visits, durable medical equipment, emergency room care, gym membership, home and community-based services (Elderly Waiver), home health services, hospital care, interpreter services, labs and X-rays, nursing home care, online health coaching, prescription drugs, personal care attendant services, and support for tobacco cessation.
Care coordination also covers transportation coverage to and from medical, dental, and mental health appointments.
Care Coordination Cook County PHHS has two licensed social workers providing Care Coordination to individuals enrolled in any of the managed care programs described above. The coordinators reach out to all newly enrolled members, and, for those members interested in engaging in services, perform assessments of health and safety needs.
Care Coordinators work with each member to develop a personalized care plan that identifies formal and informal supports, health needs, and goals. Care Coordinators remain in contact with members periodically as delegated by each health plan. Individuals with higher needs may have more frequent contact with their Care Coordinator, especially during times of transition, i.e., medical crisis or a change in condition indicating a need for increased care.
Care Coordinators can help members resolve medication issues, scheduling medical appointments, answering questions about health insurance, making choices regarding care and arranging for services to help individuals remain living in their homes for as long as safely possible.
Study shows improved outcomes for seniors enrolled in MSHO
The Centers for Medicare and Medicaid Services (CMS) recently published the Minnesota Managed Care Longitudinal Data Analysis Study. The study found that seniors enrolled in the integrated MSHO program experience improved outcomes. This study provides strong support for continued integration of Medicare and Medicaid for people eligible for both programs. The study compared the experiences of similar beneficiaries inside and outside of MSHO and found that MSHO enrollees were:
. 48 percent less likely to have a hospital stay, and those who were hospitalized had 26 percent fewer stays.
. 6 percent less likely to have an outpatient emergency department visit, and those who did visit an emergency department had 38 percent fewer visits.
. 2.7 times more likely to have visited a primary care doctor at least once in the year.
Learn more about Care Coordination services offered by Cook County PHHS at the April 16 PHHS board meeting. Information and resources are also available by calling 218-387-3620 or visit Cook County PHHS Monday- Friday, from 8 a.m. to 4 p.m., at 411 W. Second St., Grand Marais. Online at www.cookcountyphhs.org or “Like” us on Facebook @CookCountyPHHS.
County Connections is a column on timely topics and service information from your Cook County government. Cook County—supporting community through quality public service.
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