Team Care

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Team Care

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1. Team Care Department of Vermont Health Access

2. Revised 2/8/11 2 What is Team Care? The Team Care program is for beneficiaries with Vermont health care coverage who need extra help getting appropriate care.

3. Revised 2/8/11 3 What is Team Care? DVHA places beneficiaries in Team Care if proven they are having difficulty maintaining a controlled supply of narcotics. Better care is achieved through coordination of their medical services.

4. Revised 2/8/11 4 What is Team Care? While in the program beneficiaries are assigned to one provider and one pharmacy. If they need specialized services they may also have specialists assigned to administer their care.

5. Revised 2/8/11 5 Team Care Criteria Non compliance with narcotics contract. Duplicate services received from more than 2 providers and/or pharmacies. High Emergency Dept. usage. Emergency Dept. visits at multiple hospitals. Pill counts demonstrate inappropriate utilization. Arrest, conviction, or on probation for selling drugs. Altered or forged prescriptions.

6. Revised 2/8/11 6 How Team Care Works Beneficiaries choose a PCP and a pharmacy. Specialists are included as needed (ie: mental health, cardiologist, etc.). If beneficiaries do not choose a PCP and/or pharmacy, we assign one based on where they live, which doctor they have been seeing, and where they have been filling their prescriptions.

7. Revised 2/8/11 7 How Team Care Works We send beneficiaries a letter letting them know they are being placed in the program, and ask them to choose a PCP and pharmacy. If the beneficiary is not currently a patient, the beneficiary must confirm the physician is willing to accept them.

8. Revised 2/8/11 8 How Team Care Works Beneficiaries may call us with the information or return the form. Once we receive the information, it is entered into Rx Claims.

9. Revised 2/8/11 9 How Team Care Works An Enrollment Notice is mailed to the beneficiary. The PCP, pharmacy, and any specialists assigned receive a copy.

10. Revised 2/8/11 10 How Team Care Works Beneficiaries in Team Care may only have their prescriptions paid for if the scripts are: written by their assigned provider, and purchased at their assigned pharmacy

11. Revised 2/8/11 11 How Team Care Works Team Care does not restrict doctor visits, it only restricts prescription purchases.

12. Revised 2/8/11 12 How Team Care Works If beneficiaries try to fill a script which was not written by their Team Care provider, the claim will be denied. “Prescriber Not Authorized for this Beneficiary. Call DVHA at 802-879-5913.”

13. Revised 2/8/11 13 How Team Care Works If they try to fill a script at a pharmacy other than their Team Care pharmacy, the claim will be denied. “Pharmacy Not Authorized for this Beneficiary. Call DVHA at 802-879-5913.”

14. Revised 2/8/11 14 General Information Team Care is for no less than twenty-four months of continuous compliance. Discharge is not automatic. They may request to be taken out of Team Care.

15. Revised 2/8/11 15 Requesting a New PCP or Pharmacy Requests must be in writing. Must include explanation of why they would like to make the change. Requests are evaluated to see if the change is appropriate.

16. Revised 2/8/11 16 Paying Cash for Scripts Beneficiaries may pay cash for their scripts. Pharmacists can refuse to accept cash.

17. Revised 2/8/11 17 VPMS Vermont Prescription Monitoring System Tracks the prescribing and dispensing of drugs most likely to lead to abuse, addiction or diversion.

18. Revised 2/8/11 18 VPMS Data is always available to providers online through the VPMS website.

19. Revised 2/8/11 19 VPMS Web-based application used by prescribers and pharmacists. Tool for better patient care. Reduces danger of addiction, overdose, or diversion.

20. Revised 2/8/11 20 VPMS Division of Alcohol & Drug Abuse Programs Meika Zilberg, MS 108 Cherry St, PO Box 70 Burlington, VT 05402-0070 Phone: 652-4147 Email: [email protected]

21. Revised 2/8/11 21 Team Care Referrals Complete a Health Care Fraud, Abuse & Team Care Referral Form. Click on “Downloads” then “Forms.”

22. Revised 2/8/11 22 Team Care Contact Information Joyce Desany: 879-5982 [email protected] Kim LaFrance: 879-5913 [email protected] Fax: 879-5651

23. Revised 2/8/11 23 Member Services Refer beneficiaries to Member Services. 1-800-250-8427

24. Revised 2/8/11 24 Questions

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