Listen to some pre-conference comments from our audio conference presenters.

There are a number of strategies that can reduce the number of hospital admissions and re-admissions among the dually eligible Medicare and Medicaid population, ranging from polypharmacy programs to in-person and/or telephonic coaching. During this 90-minute audio conference on CD-ROM, we examined what strategies are most effective in managing these transitions and the impact these programs can have on admission rates, length of stay and re-admission rates.

Industry experts Diane Flanders, director of coordinated care systems at MassHealth, a unit that oversees the state’s integrated Medicare-Medicaid managed care programs, including Senior Care Options (SCO) and the Program of All-inclusive Care for the Elderly (PACE), and Sarah Keenan, clinical liaison with Medica, described how to create a coordinated care management approach to manage care transitions for dually eligible Medicare and Medicaid patients.

You will get details on how to:

• Lower re-admission rates by managing the post-hospital transition period;
• Manage the doctor-to-doctor transition;
• Develop effective targeting strategies that can be used to identify those patients who are at greatest risk for experiencing complicated care transitions;
• Create a "medical home" that can aid in managing transitions;
• Understand and maximize the role of health coaches, patient navigators and case managers in care transitions;
• Develop polypharmacy programs to avoid adverse drug interactions;
• Create treatment plans and inpatient discharge instructions that patients truly understand;
• Integrate chronic care models with home and community-based services; and
• Address the needs of the dually eligible Medicare and Medicaid patient.

PRE-CONFERENCE COMMENTS FROM OUR PRESENTERS:

Sarah Keenan describes the inevitable breakdowns during care transitions and how MSHO's "care coordination" efforts to ensure communication between providers and follow a patient seamlessly through transitions of care:

Due to the flexible nature of MassHealth's Senior Care Options model, its providers do not have to stay within traditional Medicaid-Medicare rules and fee-for-service limitations. This empowers providers to offer on-site visits and freely determine other appropriate avenues of care, explains Diane Flanders, director of coordinated care systems for MassHealth:

Here's what participants said about the live program:

The conference was informative, clear and helpful...a comprehensive presentation about programs for special needs populations," said Kathy Thurston, director of clinical programs at AXIS Healthcare.

The speakers "provided ways to integrate and improve care for those in need," said Migna Miles, a Medicare advocate with Affinity Health Plan

WHO WILL BENEFIT FROM THIS AUDIO CONFERENCE?

CEOs, medical directors, disease management directors, managers and coordinators, health plan executives, care management nurses, state Medicaid directors, and business development and strategic planning directors.

Available in three formats

• CD-ROM for computer play
• CD-ROM for stereo play
• On Demand version accessible online

Please note the stereo version ships as two CD-ROMs, whereas the .mp3 version ships as one CD-ROM.

ABOUT OUR PANELISTS:

Diane Flanders

Diane Flanders is director of coordinated care systems at MassHealth, a unit which oversees the state’s integrated Medicare-Medicaid managed care programs, including Senior Care Options (SCO) and the Program of All-inclusive Care for the Elderly (PACE). Prior to working for the Commonwealth of Massachusetts, she held several clinical and administrative positions in community health and home health in the Boston and Denver areas.

Flanders holds a bachelor’s degree in Nursing from Boston University and a master’s degree in Health Services Administration from the Harvard School of Public Health.

Sarah Keenan

Sarah Keenan is a registered nurse, certified in geriatrics, is the clinical liaison for Medica Health Plan’s DUAL Solutions product. This product provides medical assistance, Medicare, and waivered services to seniors and operates through the Federal Special Needs Plan known as Minnesota Senior Health Options (MSHO).

Keenan has worked with the senior population as a director of nursing at a skilled nursing facility, as a care coordinator for institutional and community-based populations and most recently as the liaison for county-based care systems providing the Minnesota Senior Health Options benefits. She represents Medica on the Minnesota Department of Human Services’ workgroup on Care Coordination.

Keenan obtained her Bachelor of Science in Nursing at Montana State University along with a major in Community Health.