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Medicare / Medicaid – MyCare Ohio

Medicare / Medicaid – MyCare Ohio

The Ohio Consumer Voice for Integrated Care (OCVIC) is a coalition led by UHCAN Ohio to assure that the managed care plans meets the needs of the adults on the MyCare Ohio Plan. MyCare Ohio is a demonstration program that coordinates physical, behavioral, and long-term care services for individuals over the age of 18, who are eligible for both Medicaid and Medicare. In late 2012, Ohio became the third state in the nation to receive federal approval for its plan to coordinate benefits for residents covered by Medicare and Medicaid.

MyCare Ohio began in May 2014 and is being implemented in 28 counties Ohio counties. There are over 100,000 individuals enrolled in the MyCare Ohio program who either chose or were assigned to one of five health plans. MyCare Ohio is a 3 year demonstration and will be evaluated by the Ohio Department of Medicaid and the Centers for Medicare and Medicaid Services at the end of the demonstration.


100000
Individuals enrolled in Mycare ohio program

The goal of MyCare Ohio is to:

    • Encourage choice and self-direction (consumers direct the care they receive).

    • Offer support for individuals so they can remain independent and in their community.

    • Provide care management that includes face-to-face visits in the home and community.

 

Adults who are dual eligible often face a number of challenges:

    • Limited care coordination (communication and services are not well coordinated between Medicare and Medicaid)

    • Medicaid and Medicare coverage is inconsistent, confusing and difficult to navigate

    • Multiple health care needs e.g. medications, personal care, and assistance with chores

OCVIC has worked with the plans and the Ohio Department of Medicaid to navigate this significant change. UHCAN Ohio and its OCVIC partners have done this by bringing together the voice of consumers and by advocating for effective inclusion of those voices in the quality improvement of the system. OCVIC listens to consumers and brings issues and solutions to the plans and the Ohio Department of Medicaid.

As the program matures, OCVIC continues to lift up issues that consumers care about and focuses on the plan’s consumer advisory committees, making sure consumers have access to the care they need.

Consumers are the best source of information on the problems they face and can provide meaningful and valuable input on potential solutions. UHCAN Ohio encourages the plans to ensure that the advisory committees are integrated into their quality improvement process and represent the diversity of the population served so that real progress is made for all Ohioans – regardless of their income or ethnicity.

 
 
 


Objective

    • Ohio Department of Medicaid convenes a MyCare Ohio health equity workgroup.
    • The workload for care managers mirrors Passport and is stratified by complexity.
    • All five MyCare Ohio plans develop consumer advisory committees that provide meaningful quality improvement feedback to the plans.
    • Plans make systemic improvements to improve access to care for consumers
    • UHCAN develop processes to facilitate two-way communication with members of the consumer advisory committees to contribute to advocacy that improves access, affordability, and quality of healthcare.

Accomplishments

    • UHCAN Ohio has trained consumer advisory committees for two of the MyCare Ohio plans to help the participants provide meaningful input on system changes that will lead to quality improvement.
    • OCVIC Coalition leadership meets regularly with the leadership of Medicaid, the managed care plans, and consumers to communicate common concerns of individuals with MyCare Ohio.
    • UHCAN conducted a survey of MyCare Ohio members to identify the challenges they are having in getting quality healthcare under the plans. The two major findings were problems with care coordination and durable medical equipment. Since those findings, the plans have made major strides on both issues.

Leadership Team

    • Ability Center of Greater Toledo
    • Benjamin Rose Institute on Aging
    • Center for Disability Empowerment
    • Center for Independent Living Options
    • Contact Center
    • Disability Rights Ohio
    • Easter Seals of Ohio
    • Legal Aid Society of Columbus
    • Linking Employment Abilities and Potential
    • Ohio Association of Area Agencies on Aging
    • Ohio Olmstead Task Force
    • Ohio Poverty Law Center
    • Ohio Association of Retired Americans
    • Ohio State Independent Living Council
    • Pro Seniors



Patient Centered Medical Home

Through patient centered medical homes, UHCAN Ohio is working to incorporate the voices of patients and their families into the design of care. We are building consumers involvement in quality improvement into the design of patient centered medical homes. This consumer involvement is accomplished through groups referred to as patient family advisory committees. We are advocating for effective patient family advisory committees that can provide meaningful input into the way care is provided.

 
 


Objective

    • Train fifteen patient family advisory committees that are ready to provide meaningful quality improvement feedback to patient centered medical homes.
    • Convince the Office of Health Transformation to support the design of patient centered medical homes that include meaningful engagement of patients and families.
    • Create a mechanism to enable two-way communication with members of patient family advisory committees to contribute to advocacy that improves access, affordability, and quality of healthcare.
    • Convince the Office of Health Transformation to create a state innovation model committee on health equity.



Accomplishments

    • The Office of Health Transformation incorporated changes to the patient centered medical home model that reflected UHCAN Ohio comments on the relationship with consumers including getting input and sharing the results of surveys and quality improvement efforts.
    • UHCAN Ohio worked with Community Catalyst to create training materials and guidance for patient and family advisory council training.


Staff Contact

Steve Wagner
swagner@uhcanohio.org
614-456-0060 x222

Action

    • Partner
    • Consumer
    • Activist
    • Reporter
    • Funder

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