Montgomery County Care Update

1. Montgomery County Care Update October 26, 2012

3. What is Montgomery County Care? • Announced in April 2010 as limited-benefit, pilot health services program for medically uninsured residents of Montgomery County not eligible for Medicaid • Intended as a bridge to expanded Medicaid and health insurance exchanges of the Affordable Care Act • Funded by Montgomery County Human Services Levy • Provides a primary care medical home through the Community Health Centers of Greater Dayton, Five Rivers Health Centers and private practice PCPs • CareSource donates administrative support • 3,100 members

4. How did it originate? • Montgomery County Healthcare Safety Net Task Force recommended improvements in the healthcare safety net • Estimated 61,000 adults ages 18-65 in Montgomery County lack health insurance • Nearly one in five working-age adults • Unemployed, not eligible for Medicaid • Working poor who don’t receive health insurance from employer

5. Who’s eligible? • Uninsured residents of Montgomery County • Not eligible for Medicaid or Medicare • Ages 19-64 • Household income < 200% Federal Poverty Level. Gross monthly income must be below: • $1,862 (family size of 1) • $2,522 (family size of 2) • $3,182 (family size of 3) • $3,842 (family size of 4)

6. What are the program goals? • Increase use of primary care medical home • Help manage chronic conditions (cardiovascular, diabetes, asthma) • Improve prevention and wellness • Reduce unnecessary emergency department usage • Help coordinate healthcare services • Encourage eligible Montgomery County residents to enroll in Medicaid

7. What’s covered? • Primary care office visits ($5 co-pay) • Specialty consultation ($10 co-pay), limited outpatient procedures • X-ray ($5 co-pay) • Generic prescription formulary, plus selected insulin, diabetic supplies and asthma meds ($5 co-pay) • Outpatient lab services through CompuNet (no co-pay) • Case management for higher-acuity members • CareSource 24 nurse advice line • Behavioral health counseling through CHCGD and FRHC

8. What’s not covered? • In-patient hospital stays • Emergency department and urgent care • Specialist procedures other than limited GI, dermatological (excisions/biopsies), podiatry for members with diabetes • Dental • Vision • Obstetrics • Transportation and ambulance • MRI, CT, ultrasound • Behavioral health except through CHCGD and FRHC

9. Case Management • Members with chronic disease (diabetes, heart disease, asthma) are assigned to a CareSource case manager • Case managers work telephonically with members to discuss their medical condition, education they may need, medications they receive and overall treatment • Case Management helps “connect the dots” for all members to services outside the scope of MCC, such as food and housing assistance, dental, vision and utilities.

10. Enrollment • Principal limiting factor in enrollment of new members is availability of PCPs • Most current members were enrolled as established uninsured patients of CHCGD and FRHC • Open enrollment suspended in late 2011 due to lack of PCP capacity • Names of eligible applicants placed on a waiting list • Eligible applicants can be enrolled if they are established with a private practice PCP participating with CareSource

11. MCC Scorecard 2012 data reflects claims paid through 9-30-12. 2011 data reflects claims paid through 2-11-12 for dates of service between 1-1-11 and 12-31-11. 2010 data reflects claims based on dates of service between 6-1-10 (program launch) and 12-31-10. X-rays added as a covered benefit 5-1-11. 2010 CM contacts estimated. 10

12. Member Demographics • Half of MCC members are over age 50 • 1,200 are age 50-59 • More than 77% are over 40 • 62% are women • Three-quarters live in city of Dayton; as a whole represent 37 Zip codes across county • 70% unemployed (based on 2011 survey results) • More than 90% below 133% FPL 11

13. Members by Health Center 35 members are assigned to private PCP practices. 12

14. Member profiles Male, age 63 • Unemployed for three years, no health insurance • Arthritis, diabetes, cardiovascular issues • Hemoglobin A1c has dropped from 11 to 9 since enrollment in MCC • MCC has also allowed consultations with rheumatologist and cardiologist • CareSource case management has provided referrals for dental and vision care outside MCC • “I wouldn’t be taking meds without Montgomery County Care.”

15. Member profiles Female, age 56, works part-time for a large retail chain.   • Lost full-time job with benefits; currently has no health insurance • Hypertension, diabetes (within scope of MCC) • Other serious medical issues (beyond scope of MCC) • Struggles with paying rent, buying food • CareSource case management helping member navigate the health care system to obtain treatment for needed surgery

16. Member profiles Female, age 64 • Also employed part-time at large retail chain • No health insurance • Often spends days off taking care of elderly mother • Diabetes, hypertension, chronic pain • Joined MCC after hospital discharge • Since enrollment in MCC, has had no further ED visits or inpatient stays • Now able to obtain insulin for her diabetes, which is in control, and blood pressure meds • Has received flu and pneumonia vaccinations

17. Member profiles Female, age 55 • Unemployed • Suffered a pulmonary embolism • Previously paid $53.96 for lab tests (initially up to three time per week, tapering to monthly) to determine level of coagulation. These tests are now covered by MCC. • Receives Coumadin through program

18. Member profiles Male, age 22 • Type 1 diabetic • Unemployed and uninsured after breaking his collarbone • Formerly paid $200 per month for insulin, now able to obtain for $10 in co-pays

19. MCC going forward • Program continues through 2013