Ohana Proposal- RFP-MQD-2013-007.Pdf
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70.300 Proposal Narrative The proposal narrative shall clearly and concisely condense and highlight the contents of the proposal and provide DHS with a broad understanding of the entire proposal. The proposal narrative shall explain how the offeror will implement the CCS program consistent with the requirements of this RFP if a contract is awarded to them. ‘Ohana Health Plan, Inc. (“’Ohana”) is pleased to provide a response to RFP-MQD-2013-007 (“RFP”) for behavioral health services to Medicaid recipients diagnosed as seriously mentally ill.[1] As you will see by our proposal, ‘Ohana is uniquely qualified to meet the requirements of this RFP through our planned provision of an integrated medical and behavioral health services solution for eligible Hawaii residents. We believe we are well positioned to fulfill all of the RFP’s requirements by the prescribed timeline for the reasons set forth below. ‘Ohana has national and local experience providing behavioral health services in a managed care environment to the targeted SMI population. ‘Ohana is a locally managed and operated subsidiary of WellCare Health Plans, Inc. (“WellCare”) , with over 165 Hawaii-based employees on the islands of Oahu, Maui, Kauai, Molokai and the Big Island. Together with our parent company and affiliates, ‘Ohana has deep experience coordinating high quality behavioral health services for Medicaid and low-income populations and plans to bring this experience to bear in fulfilling all of the RFP’s requirements. Through our parent company and affiliates, we have over twenty years of experience in working with the mental health community and providing high quality managed behavioral health care. As you’ll see in our proposal, WellCare currently operates plans in states that utilize managed care for their specialty behavioral health services. ‘Ohana has access to our corporate and sister markets’ behavioral health clinicians and physicians, corporate behavioral health leadership team and all of their resources to enhance our deep local knowledge of the behavioral health system of care in Hawaii. We are closely tied to our Hawaii membership and state partners, and understand the nuances of operating a business in Hawaii. Most importantly, we already operate a behavioral health program and network for our existing QUEST, QExA, and Medicare plans. Our behavioral health program for QUEST, which programmatically is almost identical to the CCS program, has been approved by DHS and we already have an active membership receiving behavioral health services in the community. Our QExA membership and Medicare membership also have significant behavioral health needs and ‘Ohana has been arranging for these services, either directly or in collaboration with our community providers, since we began services in Hawaii. We strongly believe [1] The proposed BHO is WellCare Health Insurance of Arizona, Inc., d/b/a “’’Ohana Health Plans, Inc., an indirect wholly-owned subsidiary of WellCare Health Plans, Inc. RFP-MQD-2013-007 ‘Ohana Heath Plan Page 1 that we bring significant local and national behavioral health experience and can best serve this population. Our proven ability to implement programs in Hawaii and scale operations to meet changing contractual requirements and/or the needs of the membership As an existing Medicaid contractor, ‘Ohana has an experienced and fully staffed management team in place that will oversee implementation of the CCS contract. Our Hawaii management and associates will be supported by WellCare’s Corporate Market Expansion Department, which is responsible for managing implementation of new programs (and program expansions) and ensuring timely completion of all corporate-level readiness activities (e.g., loading of provider contracts into the management information system). ‘Ohana recognizes that the starting population for this contract is small and we believe we have the existing local infrastructure, network and staffing to successfully serve this membership while keeping administrative expenses within the range found in the databook. We believe that through the addition of some key positions, as detailed later in the proposal, and leveraging our current operations, we will provide to DHS not only a known quality partner, but a financially stable one as well. We believe that ‘Ohana would be able to implement the CCS contract as it is written today and we would be prepared to expand the program to additional membership at any time in the future. Our proposed behavioral health care program will be part of an integrated system of care delivered by our existing behavioral health providers, pharmacies and community affiliates. As ‘Ohana is not a direct service provider, our proposed behavioral health care model will separate care delivery from care management functions. We will not be providing direct behavioral health services; rather, we will provide the CCS membership choice of community providers including case management agencies. We recognized that the key to our members’ health and wellness is to provide members access to the fullest and broadest array of behavioral health services professionals throughout our local communities. ‘Ohana’s Network Development and Management Plan has been tested by time and currently provides access to services for over 26,000 Medicaid members across six islands. In addition to our focus on providing superior care for mental health and substance abuse conditions we understand the geographic challenges involved in operating a statewide network in Hawaii. Where provider gaps exist due to shortages in the physician workforce we have demonstrated experience ensuring our transportation vendor provides inter-island and mainland travel assistance so our members receive treatment in an efficient and timely manner. We already have existing networks and systems of ancillary services such as pharmacy and transportation. Given the shortened timeframe for implementation, we believe that having our full network already in place and an existing relationship with the BH provider community will minimize the risk of disruption to the membership during transition. RFP-MQD-2013-007 ‘Ohana Heath Plan Page 2 Our approach to community case management and our commitment to recovery and member- empowering treatment Our proposed behavioral health care program will offer the CCS membership the full choice of traditional case management by our community providers. We recognize the new licensure requirements and will be committed to ensuring our provider partners are in full compliance with the required level of licensure as well as remaining compliant with ratios. ’Ohana will bring our expertise of managing providers which includes quality oversight, improved outcomes and accountability. With all of the community case management agencies already in our network, we are able to implement this core portion of the CCS program immediately. ‘Ohana also has a long term vision for the case management system for SMI members in our community. Our vision for a future clinical model that fully embraces the fundamental components of recovery promoted by the Substance Abuse and Mental Health Administration. Our vision for member- centric recovery and resiliency is best exemplified by our proposed “HOPE” program. Standing for (1) Health and Home, (2) Opportunity and Optimism, (3) Purpose and Peace of Mind, and (4) Empowerment and Energy, we intend to initiate ‘Ohana’s HOPE program by working with members to identify choices for care that exist for their particular circumstances. Members who do not elect to participate in the HOPE program will always have the option of having care delivered through the conventional case management approach. Consistent with principles of choice, members would always have the option of moving from our traditional case management to a member-directed approach (or vice versa) during the care delivery process. ‘Ohana would work with our case management agencies on implementing this new approach which is described in more detail in the proposal. Our ability to improve integration of medical and behavioral health care We believe ‘Ohana’s experience in the medical side of managed care enhances our behavioral health expertise. Who better to help integrate care than a BHO with experience with both Hawaii’s medical and behavioral systems of care? ‘Ohana will further support our community case management agencies by bringing a clinical model that focuses on the integration and coordination of medical and behavioral health care. Historically, the mental health community has not done an effective job in collaborating with members’ PCPs or other medical providers. We believe ‘Ohana’s Medical-Behavioral Case Management Program (“MBCM”) distinguishes us through its focus on the integration and coordination of medical and behavioral health care. ‘Ohana’s MBCM team will include a BHO Medical Director, ‘Ohana’s Medical Director, a Clinical Director, a Behavioral Health Director, a Pharmacy Director, and Case Managers. Our MBCM will emphasize the importance of coordination among primary and specialty care physicians, allied health care providers, and behavioral health providers for our members with co-morbid medical disorders. ‘Ohana has a proven track record with our community providers and our membership that shows our dedication to enhancing the care for members with behavioral health disorders. RFP-MQD-2013-007 ‘Ohana Heath Plan Page 3 ‘Ohana already has a robust offering of behavioral health providers across all islands. Our understanding