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Fast Facts: Syncare Missouri P: 1(866) 835-1613

Missouri Office

Partnering to Improve Healthcare.

13545 Barrett Pkwy Dr Suite 300 Ballwin, MO 63021 www.SynCareMo.com

Description

General Information: info@syncaremo.com

SynCare Missouri® is an innovator in disease and case management with discrete expertise in managing asthma, diabetes, prenatal, obesity and other chronic co-morbid conditions. SynCare Missouri’s flexible and scalable services are designed to improve the health and well-being of Medicaid patients, providing additional resources to primary care and specialty providers. This is done through intensive case management, care coordination, pharmacy management and behavior modification. The goal for our flexible, value-driven programs is to reduce administration costs and increase ROI for our clients, while creating a broad and encouraging support system for members: • • • • • • • •

Case Management Program

Extending the physician-patient partnership into the community and workplace Managing people – not diseases – through individualized care plans and risk assessments Providing nursing and telemonitoring Supporting minority and non-English speaking populations Coordinating care across service providers Reducing the onset of co-morbid conditions Promoting behavioral change through member incentives Empowering members to self-manage chronic healthcare conditions

SynCare Missouri’s customizable case management programs follow national guidelines with the objective of improving clinical outcomes and lowering associated medical expenses. By focusing on prevention, education and behavioral changes, SynCare Missouri strives to improve the care of people living with chronic diseases and reduce short and long-term health care costs. • SynCare Promise Program™ for Prenatal Care • SynCare CompCare Program™ for Complex Case Management • SynCare Secure Program™ for Hospital Discharge Planning and Home Healthcare Support to prevent readmission • SynCare Sweet Life Program™ for Diabetes Management • SynCare Aspire Program™ for Asthma Management • SynCare Healthy Life Program™ Risk Assessments/Surveys

Leadership

Franky Johnson, President Terri Morris, Vice President of Operations

Ownership

Privately owned. Certified Minority Business Entity in Indiana, Illinois, Kentucky, New Jersey, Pennsylvania, Tennessee and Virginia.

For more information visit: www.syncaremo.com.

Last Rev: June 2011


FAQ’s: ASSESSMENT ADMINISTRATOR FOR

HOME AND COMMUNITY BASED SERVICES

Missouri Office

P: 1(866) 835-1613 Partnering to Improve Healthcare.

13545 Barrett Pkwy Dr Suite 300 Ballwin, MO 63021 www.SynCareMo.com

Description

General Information: info@syncaremo.com

SynCare Missouri is the Assessment Administrator for Home and Community Based Services for the Department of Health and Senior Services (DHSS). As the assessment administrator, SynCare Missouri performs objective assessment using the InterRAI tool to Medicaid waiver eligible adults who wish to remain in the least restrictive community settings. The following are the frequently asked questions with answers when providers are engaged: Who is SynCare Missouri? SynCare Missouri is a disease management company that provides services to private and public clients, helping individuals manage their disabilities and chronic illnesses to improve overall health outcomes. We are a certified minority and women business enterprise with Stephanie E. DeKemper, Owner/CEO. Our leadership team has many years of experience working with Medicaid population. Our culturally competent organization is committed to the ongoing practice of integrating knowledge, information and education to support individuals, families, communities and subgroups within the Home and Community Based Service (HCBS) arena. Where is SynCare Missouri’s office located? Our office in Missouri is located in Ballwin. The Home and Community Based Services (HCBS) program launched on May 19, 2011. The company will be filling more than 135 positions using qualified applicants who reside throughout the State of Missouri.

Case Management Program

What value driven programs does SynCare Missouri manage currently? SynCare Missouri currently manages value-driven programs that only support the Medicaid population that create a broad and encouraging support system for the participating members. We are a green company and technologically savvy using data processes to improve quality of life and compliance with provider and personal care plans. Our signature programs are: • The SynCare Promise Program™ for Prenatal Care • The SynCare CompCare Program™ for Complex Case Management • The SynCare Secure Program™ for Hospital Discharge Planning and Home Healthcare Support to prevent readmission • The SynCare Sweet Life Program™ for Diabetes Management • The SynCare Aspire Program™ for Asthma Management • The SynCare Healthy Life Program™ Risk Assessments/Surveys How does SynCare Missouri collaborate with providers, suppliers, and other HCBS stakeholders? SynCare Missouri is committed to making a positive impact in the Home and Community Based Services communities that work to protect values of the elderly and disabled. We have a track record of supporting organizations through cooperative giving whose missions align with our own, and we know the importance of giving back to the communities in which we share human resources. We will also be seeking members to be on a statewide advisory committee group in the near future. Members of this committee will include participants and representatives from the Home and Community Based Services community such as physician, suppliers, or healthcare and medical management providers. The committee will provide advice and address concerns. A charter for the advisory group is under development. If you are interested in participating in this advisory group, you may contact Terri D. Morris, RN, MSN, ANP-BC at tmorris@syncaremo.com

If I have additional questions what are my options to contact SynCare Missouri? If you have any additional questions about the program, please contact info@syncaremo.com.

June 2011


How We Work With Providers Reducing costs and increasing quality of life for at-risk populations Acting as capable health care partners to primary care physicians, SynCare Missouri provides comprehensive disease management services that are designed to improve the quality of life for at-risk members and reduce both short and long-term costs. Following national, evidence based treatment guidelines, we develop individualized care plans that are driven by physicians and administered by RN's, LPNs and Social Workers as appropriate to each member's condition.

Proactive Support of the Physician-Patient Relationship

Member Engagement and Retention Strategies

SynCare Missouri’s continuum of care applies multiple strategies for engendering trust and productive interactions between primary care physicians and members, including:

• Ensure programs offered by the SynCare Missouri Medical Management Department meet evidenced-based guidelines. • Make at least three initial contact attempts with members referred to SynCare Missouri. • Ensure all participating members complete an assessment and be risk stratified. • Develop a personalized care plan for each member that completes an assessment and ensure that plan is followed and completed for as long as the member continues participation. • Ensure clinical notes for all participating members are sent to the provider, subject to the provider agreement.

• • • • •

Education and Self-management Support Behavior Modification Community Resources Delivery System Design Clinical Information Management

Working proactively to support the physician-patient relationship, we maintain an ongoing dialogue with physicians to optimize clinical outcomes: • Seeking counsel and confirmation on risk stratification and assessment. • Providing access to electronic medical records (EMR). • Sharing notes on each patient's progress, participation and compliance. • Scheduling periodic case management reviews. • Assisting physicians in scheduling appointments. • Acting as a resource for information that is pertinent to each physician's practice. In addition to patient information, we provide general communications and program updates to our physicians, customizing information sharing to fit each physician's preference -- such as fax, mail or email. Our commitment to collaboration is a keystone of SynCare Missouri’s unique disease management model.

Long-Term Quality and Outcome Gains • Increase the percentage of members who meet Healthy People objectives established by the US Department of Health and Human Services. • Improve the percentage of members who meet nationally set benchmarks established by disease management and care coordination programs. • Exceed national standards for call center performance. • Reduce the percentage of members that utilize emergency rooms for Primary Care. • Reduce hospital re-admissions.

For more information call 1 (866) 835-1613 or email info@syncaremo.com


Our Care Management Process Improving the Quality of Services and Care Coordination Committed to providing efficient and effective care, SynCare Missouri applies continuous process improvement to ensure optimum quality of clinical care and operational excellence.

Member Care Management Process 1.

Member Enrollment - The member referral sources for care management will be pre-selected and provided to SynCare Missouri by the client. Members may also be referred into the programs from outside sources via the “New Member Referral Form.” Upon receiving the member data, SynCare Missouri will contact the individuals to verify eligibility with the client.

2.

Opt-In/Opt-Out Processing - The Opt-In/Opt-Out processing is a one-time procedure in which individuals indicate whether they wish to participate in the program. Once an individual has opted in, SynCare Missouri will assign the member a care coordination team based on risk assessments, location, and/or cultural requirements.

3.

Risk Assessment & Stratification - SynCare Missouri administers an assessment upon initial member contacts to survey and stratify members into appropriate risk levels, identify psychosocial, environmental and medical concerns, and connect members with community support systems. Upon stratification, routine follow-ups are determined and scheduled immediately.

4.

Incentives - Members who enroll and participate in the SynCare Missouri programs will receive incentives. These incentives can vary depending on the program(s) enrolled and where permissible by law.

5.

Telephonic Interactions - SynCare Missouri provides telephonic support as needed to members, based on their risk stratification level. Interactions are focused on goal-oriented, health coaching techniques to improve the members’ holistic health.

6.

Face-to-Face Interactions - Face-to-face interactions are similar in content to the goals of telephonic support. These interactions, however, are typically reserved for the high-risk members. Members will initially be visited by a Registered Nurse (RN) and may have follow-up appointments by a Community Health Educator (CHE), Licensed Practical Nurse (LPN), or Counselor.

7.

Educational Materials - SynCare Missouri provides in-depth health education materials that are case specific. These may be delivered as part of the program, upon request by the member or via the Web.

8.

Community Resource Linkage - During a member’s enrollment, SynCare Missouri may identify additional needs and provide community resources to help address the issue. Social Workers and CHEs will work diligently to address any community resource issue that is identified.

9.

Physician Participation - The recognition of the value and strength of a working physician-patient relationship allows SynCare Missouri to further affect member’s health concerns. SynCare Missouri communicates regularly with physicians to help encourage the review, adjustment or enhancement of member care plans.

10. Data Management - SynCare Missouri will follow all members through the SynCMS data system. This system is a real-time, HIPAA compliant database that allows SynCare care management teams to provide swift and effective solutions.


Aspire Program

TM

Improving outcomes, productivity and quality of life with asthma management SynCare’s Aspire Program is designed to contain medical costs and improve the quality of life for people with asthma, offering personalized case management services to: • • • • • •

Increase adherence to self-management practices Reduce emergency room admissions Reduce hospitalizations Reduce number of work days lost Reduce number of cancelled activities Increase symptom free days

SynCare’s Case for Asthma Management

Our Custom-Designed Physician-Patient Partnership

Asthma is the most costly and common disease in the U.S., affecting 1 in 15 individuals at a social and economic cost of nearly $18 billion a year.

SynCare’s Aspire Program addresses both the financial and human cost of asthma through custom-designed asthma management based on a patient’s severity of illness.

According to the Asthma and Allergy Foundation of America (AAFA) each day in America:

Based on claims information, health risk assessments and predictive modeling, we extend the physician-patient partnership into the community, providing one-to-one interactions, health education, motivational interviewing and behavior modification. In addition to targeting environmental triggers, SynCare provides counseling to address emotional triggers of the disease.

• • • • •

40,000 people miss school or work due to asthma 30,000 people have an asthma attack 5,000 people visit the emergency room due to asthma 1,000 people are admitted to the hospital due to asthma 11 people die from asthma

Among children ages 5 to 17, asthma is the leading cause of school absences from a chronic illness, accounting for an annual loss of more than 14 million school days per year and more hospitalizations than any other childhood disease. It’s estimated that children with asthma spend nearly 8 million days each year restricted to bed.

Program components focus on improved medication management, reduced environmental risk and intense education to help patients: • • • • • • •

Understand the nature of their illness Recognize its symptoms Learn how to respond to an attack Identify and eliminate environmental triggers Understand available medications and treatment goals Adhere to self-management practices Appropriately use medications

The SynCare Aspire program is developed in accordance with guidelines and recommendations established by the National Asthma Education and Prevention Program (NAEPP) Expert Panel Guidelines for the Diagnosis and Management of Asthma. Source: http://www.aafa.org/

For more information call 1 (866) 835-1613 or email info@syncaremo.com


CompCare Program

TM

Containing costs and improving quality of life with complex care SynCare’s CompCare Program for medically complex cases treats individuals with multiple diseases such as asthma, diabetes, hypertension, congestive heart failure (CHF) and obesity. It also addresses mental health and medication issues, as well as social service needs. Program goals are to: • Increase member knowledge of disease conditions • Reduce hospitalizations and emergency room visits • Encourage and support the member-physician relationship • Improve quality of life for the member • Increase member adherence to physician plan of care

SynCare’s Case for Comprehensive Care According to the Centers for Disease Control, chronic diseases — such as diabetes, cardiovascular disease and asthma — account for roughly 78% of all health care spending in the United States. Disrupting the lives of 1 out of 10 Americans and frequently accompanied by co-morbid conditions, these diseases have launched a national health priority to address their human and financial costs.

Caring for Members “One Body at a Time” SynCare’s CompCare Program provides personalized care plans for medically complex individuals with multiple physical and mental health issues. Because each member is unique, our philosophy is to treat “One Body at a Time” with appropriate individualized education and assistance. First, risk stratification is executed to identify members that are most likely to consume a disproportionate percentage of healthcare services due to their conditions. Once stratification is complete, high-risk members are encouraged to participate in personalized care plans. These personalized plans provide members with systematic assessments, treatment guidelines and behaviorally sophisticated support designed to help them self-manage their conditions. Working in partnership with physicians, we offer comprehensive support to prevent or reduce the severity of current conditions and increase members’ confidence and knowledge. Plans for care are developed from evidence based treatment guidelines.

Source: http://www.cdc.gov/nccdphp/

Case Management support includes: Environmental Assessment Psychosocial Assessment Appropriate Education Resources and Referrals One-On-One Interactions Medication Review Telephone follow up and support Home visits for those at highest risk

For more information call 1 (866) 835-1613 or email info@syncaremo.com


Healthy Life Program

TM

Addressing potential health care issues through early identification SynCare’s Healthy Life Program draws on health information from the fields of medicine, health education, and behavior change to: • Assess individual members’ health status • Calculate risk levels • Provide recommendations for health improvement and behavior modification

The SynCare Case for Risk Assessment In order to control health care costs, lower absenteeism and increase productivity, you must first understand if and how your members are at risk for health issues. SynCare’s Healthy Life Program addresses potential health care issues through early identification of conditions, lifestyles, and member behaviors. Generated through best practices established in our Signature Programs, Healthy Life health risk assessments can be customized to cover multiple at-risk populations or targeted towards one population.

Our Appraisals and Process Available Risk Assessments include: • • • • •

Overall Health Risk Assessment (age appropriate) Asthma Diabetes Medically Complex Prenatal

These thorough appraisals provide an effective tool in health risk identification, delivering targeted follow-up interventions for those at-risk, and tracking and analyzing population health trends over time. The Healthy Life Program does not offer Care Management follow-up services. It is designed to work in combination with additional SynCare programs or provide our Client that opportunity. The Healthy Life Program process: • • • • • • • •

Member Enrollment Opt-In/Opt-Out Processing Risk Assessment Incentive Telephonic Interactions Web Availability Data Management Client Access

For more information call 1 (866) 835-1613 or email info@syncaremo.com


Promise Program

TM

Delivering healthier babies, happier moms and lowered cost of care SynCare’s Promise Program is devised to improve clinical outcomes for expectant mothers and their newborns. Goals of the multi-faceted Prenatal care program are: • Increase early access to prenatal care • Improve compliance with routine prenatal care and proper nutrition • Improve compliance with prescribed medications including prenatal vitamins • Reduce related medical expenses associated with complications in pregnancy increase birth weights and gestational age at delivery • Decrease NICU admissions and length of stay

SynCare’s Case for Perinatal Case Management According to the National WIC Association (NWA) premature births in the U.S. cost over $26 billion a year. • On average, the first year medical expenses for a low birth-weight baby are 45 times more than those for a baby without complications. • For very low birth-weight babies, a shift of just one pound at birth can save about $28,000 in first year medical costs. • For every low birth-weight incident prevented, Medicaid costs are reduced by $12,000 to $15,000.

The SynCare Promise Program has received National Committee for Quality Assurance (NCQA) Patient and Practitioner Oriented Full Accreditation. Full Accreditation is awarded to organizations that meet or exceed NCQA’s standards for DM Accreditation.

Our Program for Comprehensive Care The Promise Program’s goal is to lower the risks and symptoms associated with high-risk pregnancy by providing comprehensive case management and support. Through risk assessments and our direct member interactions we address medical, nutritional, environmental, socioeconomic and behavioral factors, with the following concentrations: • • • • • •

Increased proper nutrition Proper weight gain and management Smoking cessation Substance abuse cessation Compliance with prenatal appointments Identification of risk factors associated with preterm labor and delivery • Development of care plans to reduce risk of preterm labor and delivery SynCare’s Promise Program has achieved: • Improved prenatal HEDIS rates • Improved postpartum HEDIS rates • Reduced NICU admissions • Reduced cost

The SynCare Promise Program is developed in accordance with the guidelines and recommendations established by the American College of Obstetrics and Gynecologists. Sources: http://www.acog.org National WIC Association (NWA), http://www.nwica.org

For more information call 1 (866) 835-1613 or email info@syncaremo.com


Secure Program

TM

Reducing costs and increasing care with hospital discharge planning and coordination of home based support SynCare’s Secure Program targets avoidable hospital re-admissions, improving quality of care and use of resources to: • Reduce in-patient hospital re-admissions • Reduce length of stay for patients that do require re-admission • Reduce hospital costs and needless benefit expenses • Increase patient satisfaction and coordination of care • Ensure the smooth and successful transition from hospital to home

The SynCare Case for Cost Management The transition from hospital to home can be risky -- particularly for patients with chronic conditions. Faced with complex, costly treatments, and sometimes conflicting and confusing instructions from different health care providers, patients and their families struggle to comply with instructions and are unable to coordinate appropriate care. This lack of coordination leads to medical errors, unnecessary tests and patient stress. It also drives up costs. In fact, avoidable re-admissions cost U.S. hospitals, public and private insurers billions of dollars each year. In a June 2007 report to Congress, the Medicare Payment Advisory Commission (medpac) noted that the annual cost of avoidable readmissions to Medicare alone averages $17.4 billion. Medpac, the Centers for Medicaid and Medicare Strategies (CMS) and other healthcare agencies have called for managed care that would not only reduce costs, but also improve quality of life for individual patients. SynCare’s Secure Program responds to that call.

Our Physician-Patient Partnership SynCare extends the physician-patient partnership into the community, providing one-to-one interactions, health education, motivational interviewing and behavior modification. We help patients understand their conditions so they can make informed health decisions and set goals for managing their conditions.

Our unique case management model reduces in-patient re-admissions, lowers health care cost, and improves clinical outcomes by creating a broad and encouraging support system to keep patients motivated and engaged. Prior to hospital discharge, a SynCare RN visits the patient in the hospital to assist with discharge planning. When the patient is discharged, the SynCare RN visits the patient within 48 hours. The nurse continues to follow the patient telephonically as needed for at least 30 days post-discharge. Case management includes: • • • • • •

• •

• • • • • • • •

Patient risk assessment and stratification Coordination of services Individualized care plans (discharge) Home environment assessments Medication reconciliation and self-management Development of a patient-centered record (a user-friendly booklet for the patient to record a brief patient history, medications, allergies, health goals and questions for the doctor). Assisting the patient with scheduling follow-up appointments with primary care physicians and specialists Providing training to the patient so that she/he has knowledge of “red flags” (signs that the patient's condition is getting worse and how to respond) Weekly telephonic interactions 24 hour access to case manager Clinical social workers to help the patient and family deal with any stress/ emotional issues Enrollment assistance in Medicaid / Medicare for patients that have no insurance. Community resources Liaison services between patient and community resource Educational materials geared towards the patient’s educational level Interpretive services as needed

Source: www.medpac.gov/documents/Jun07_EntireReport.pdf

For more information call 1 (866) 835-1613 or email info@syncaremo.com


Sweet Life Program

TM

Reducing costs and increasing quality of life with diabetes management Designed to improve quality of life, encourage compliance with physician treatment plans and decrease benefits consumption, Syncare’s Sweet Life Program aims to reduce emergency room visits, hospitalizations and pharmaceutical costs.

The SynCare Case for Diabetes Management

An Integrated Approach to Diabetes Management

According to the American Diabetes Association, there are 23.6 million people in the U.S., or 8% of the population, with diabetes. The sixth primary cause of death in the U.S., it is a leading cause of adult blindness, heart disease and stroke, high blood pressure, lower-limb amputation, kidney disease, nerve damage and periodontal disease.

SynCare’s Sweet Life Program applies an integrated approach to diabetes management.

The financial cost of diabetes is staggering – accounting for one out of every five health care dollars spent in the U.S. The Association reports that the total economic cost of diabetes in 2007 was $174 billion: • • • •

Cost of direct care: $27 billion. Chronic diabetes-related complications: $58 billion. Excess general medical costs: $31 billion. Indirect costs resulting from increased absenteeism, reduced productivity and disease-related unemployment disability: $58 billion.

In addition to encouraging compliance with physician treatment plans, our case management program seeks to reduce or delay the onset of co-morbidities through educating members on the importance of annual flu shots, routine foot, eye and dental examinations and urine testing for early (detection) of kidney damage. Using direct support, we keep members engaged, motivated and progressing – improving glycemic control, reducing glycated hemoglobin (A1C) concentrations, improving cardiovascular risk Members are provided with education that includes: • • • •

How to use the glucometer Insulin injections Use and care of the insulin pump Menu planning and nutrition

Case Management support includes: • • • •

Medication Review Environmental assessments Telephone follow up and support Home visits for those at highest risk.

SynCare’s Sweet Life Program is developed in accordance with the guidelines and recommendations established by the Indiana Consensus Guidelines for Diabetes Care adopted by the Indiana State Department of Health, and the American Diabetes Association Clinical Practice Guidelines (2004). Source: www.diabetes.org/diabetes-statistics.jsp

For more information call 1 (866) 835-1613 or email info@syncaremo.com



SynCare Missouri