Concern that takes away some local control at patient/doctor level Reduce neonates & N/A Healthy Babies $3.7M $1.4M Pros: Could be tied into Implementation Timeline: increase normal Initiative/Also Better health outcomes CMO; Could be a 12-18 mo. births combines with Care Long-term savings (by having babies CMO-driven initiative Savings Realization Timeline: Management healthier) 2-4 years Organization Changes: Systems (possibly) Communication: Providers, Members ER utilization Working with ER Allow dental Pros: be tied into Implementation Timeline: ($8.4M) departments to identify benefits for ($3.2M) Address dental needs to prevent CMO; Could be a 12-18 mo. high utilizers, identify individuals using future costs CMO-driven initiative Changes: Systems drivers of high utilization, & the ED for dental Better health outcomes Communication: Providers, encourage appropriate services Cons: Members treatment settings Initial costs Adult (non-ICF-MR) dental Expand on current N/A N/A See above Implementation Timeline: Pros: covers: initiatives and use Ensure delivery of services in Current Acute surgical care findings to identify appropriate setting Changes: Systems following traumatic and mitigate high Reduce hospital ER costs Communication: Providers, accident utilizers Members Oral surgical procedures not involving dentition & gingiva Tooth extraction if posing a serious health threat or during radiation therapy Treatment to relieve pain, eliminate
Concern that takes away some local control at patient/doctor level Reduce neonates & increase normal births N/A Healthy Babies Initiative/Also combines with Care Management Organization $3.7M $1.4M Pros: Better health outcomes Long-term savings (by having babies healthier) Could be tied into CMO; Could be a CMO-driven initiative Implementation Timeline: 12-18 mo. Savings Realization Timeline: 2-4 years Changes: Systems (possibly) Communication: Providers, Members ER utilization Working with ER departments to identify high utilizers, identify drivers of high utilization, & encourage appropriate treatment settings Adult (non-ICF-MR) dental covers: Acute surgical care following traumatic accident Oral surgical procedures not involving dentition & gingiva Tooth extraction if posing a serious health threat or during radiation therapy Treatment to relieve pain, eliminate Allow dental benefits for individuals using the ED for dental services ($8.4M) ($3.2M) Pros: Address dental needs to prevent future costs Better health outcomes Cons: Initial costs be tied into CMO; Could be a CMO-driven initiative Implementation Timeline: 12-18 mo. Changes: Systems Communication: Providers, Members Expand on current initiatives and use findings to identify and mitigate high utilizers N/A N/A Pros: Ensure delivery of services in appropriate setting Reduce hospital ER costs See above Implementation Timeline: Current Changes: Systems Communication: Providers, Members
recommendation-report12-15-2012.docx