Newsroom > DHHS News Release
FOR IMMEDIATE RELEASE
September 7, 2018
Julie Naughton, Communications and Legislative Services, 402-471-1695 (office); 402-405-7202; firstname.lastname@example.org
Providers, Recipients Praise Heritage Health, Nebraska’s Medicaid Managed Care System
Lincoln – At the Division of Medicaid and Long-Term Care’s Heritage Health Quarterly Report to the Health and Human Services Committee of the Nebraska Legislature, Medicaid providers and recipients alike praised Heritage Health, Nebraska’s Medicaid managed care system, which combines physical health, behavioral health and pharmacy benefits. Dr. Matthew Van Patton, director of the Division of Medicaid and Long-Term Care, spoke on behalf of the Division.
Mary M. Walsh Sterup, OTR/L, CHT, Owner/Partner, Central Nebraska Rehabilitation Services LLC:
Almost one year ago, in September of 2017, I testified before this committee on the struggles we as therapy providers (PT, OT and ST) were having with WellCare, mostly with their three-party authorization program Evicore, who were denying medically necessary care to WellCare patients. As a large therapy provider, we were frustrated with the frequent inappropriate denials and significant increase in administrative burden, to name just a few things that we were seriously considering not accepting WellCare patients in any of our therapy practices. At this time last September, other therapy providers around the state had already limited WellCare.
WellCare listened. They heard us. Shortly thereafter, in October of 2017, WellCare temporarily suspended their authorization process. They reached out to myself and several other therapy providers, forming an advisory committee that addressed each issue we had with Evicore and the authorization process. They streamlined their process, decreased the administrative burden, and developed a user-friendly product. They worked with us to help establish realistic norms and processes for their authorization requirements, based on industry-standard criteria, and used our professional associations as guidance.
Once the WellCare authorization system was in place, they brought several people from Evicore’s authorization team to Nebraska and to our clinics for “test runs.” They came from numerous states and were onsite as we attempted to operate within their portal/authorization system. When things did not operate as they expected, and they experienced the same frustrations we did, they vowed to get their system fixed and return for further testing. A week later, they returned to Nebraska and again met with providers in the Omaha area onsite in their clinics to ensure their system was functioning. Unfortunately I was unable to meet with them onsite due to some weather issues that occurred. (Apparently people from California and Florida are a little nervous driving to mid-state Nebraska after a skiff of snow.) However, we were able to work through things online and via the phone, and I honestly felt if I wanted them to come another time so they could work with us onsite at our clinic, they would have considered it. During this time, they further delayed returning to the authorization process until they were confident they had a functioning system in place. A measure I personally applaud – get the bugs worked out prior to throwing it out to the providers to deal with.
My message here today is to let you all know WellCare listened. They reached out to providers. They formed an advisory group and worked collaboratively with the group to figure out a solution. WellCare valued our opinions. Today, although not a perfect system, we feel much better about WellCare and working with their clients/patients. The authorization process is streamlined and easier to use. They are responding in a timely manner to therapy requests/authorizations. There is a significant decrease in the amount of administrative burden and most of the time, claims are paid timely and without complication. The bottom line – in my opinion it’s a win-win situation. It’s a win for us as a provider because we get to do what we love and provide care to our patients. But most importantly, it is a win for the patient, as they are now able to receive appropriate medically necessary therapy without delay.
Sheila Augustine, Director of Patient Financial Services at Nebraska Medicine:
At Nebraska Medicine, I am responsible for the hospital and provider billing. I have worked with UnitedHealthcare’s provider advocate Meagan Weese since 2013. I am frank and open with any questions or issues that I may be experiencing. Meagan and her team of provider advocates have the full support of the UnitedHealthcare staff and leadership. Any issue, large or small, gets immediate action.
The UnitedHealthcare provider advocates have resolved some challenges with trauma claims and credentialing that UNMC was experiencing. Communications is based upon taking action to resolve any of our needs. I take my concerns straight to UnitedHealthcare, not calling DHHS to then call UnitedHealthcare. They should hear from me and understand what I am experiencing.
UnitedHealthcare’s attention to detail and results-oriented attitude allows for my team to complete their processes and feel confident that UHC has demonstrated best effort to address our needs.
There will always be challenges within healthcare but what makes the biggest difference in working through those challenges is having a solid relationship and folks taking responsibility to do what they need to do to get the issue resolved.
Sara Ellis, Director of Patient Accounts at York General Hospital:
At York General hospital I am responsible for hospital billing. I have worked with my UnitedHealthcare provider advocate Jenn Nelson for over 2 years. Jenn has worked really hard to establish a great relationship with us.
I have great communication with Jenn and have had outstanding service from her. I know I can go to Jenn with anything and she can help me. If I have an issue Jenn will resolve it in a very timely manner, and keep me informed of the progress as it is getting resolved.
We have monthly meetings with Jenn and we talk about anything I have to discuss and she brings us proactive information about changes and provides training and education when needed.
I appreciate the way UnitedHealthcare works with York General Hospital and Jenn’s proactive approach to supporting our team. She is always informative in bringing awareness to upcoming provider expos, forums, and seminars. Those forums help my facility not only on the level of awareness to UHC requirements, but it allows York General to network on a broader spectrum with other similar facilities and build great working relationships, which I feel UHC is very supportive of.
Dayle Harlow, Revenue Cycle Manager, Fillmore County Hospital:
When the Heritage Health Medicaid program began in Nebraska on January 1, 2017, I think it’s safe to say that providers were unaware what a huge undertaking this would be. All three MCOs did their due diligence by having meetings regularly throughout the state with information about their company and tried to be as transparent as possible.
For Fillmore County Hospital, Medicaid makes up about 7% of our total payor mix, Nebraska Total Care being 4% of the total Medicaid patient population for Fillmore County Hospital. Throughout the transition, Nebraska Total Care has been extremely helpful and diligent with any and all issues we have had.
Nebraska Total Care has an excellent portal with innovative technology that helps providers work their claims, look for procedures that need prior authorized, and other policies and procedures. Additionally, they provide a provider representative resource to each provider to help with any other issues that cannot be resolved on their portal. This representative has been extremely helpful to Fillmore County Hospital, and is very responsive and timely in her responses. Additionally, she comes on-site monthly to help our billers and other staff with claim or any other questions one-on-one, to help ensure our claims are being paid correctly. Our provider representative, as well as other employees within Nebraska Total Care reach out consistently to see how things are going, which is very much appreciated.
Additionally, Nebraska Total Care has been very helpful with providing clarification for the extensive behavioral health billing process. Each MCO requires a different type of submission, and each cover different levels or practitioners differently. In the beginning stages of the adoption of Heritage Health, the behavioral health billing side was very challenging, but Nebraska Total Care helped us through it and we are now billing appropriately, as well as getting paid in a timely manner.
All in all, in my opinion, Nebraska Total Care has done an outstanding job providing enough resources to providers, aiding in claims issues and any other questions, and paying claims on time. Fillmore County Hospital and Nebraska Total Care have worked closely together and have formed an excellent provider/payor relationship, with the same goal in mind of providing quality healthcare to residents of Nebraska.
Rhonda Wells, Medicaid recipient:
I have been on Medicaid on and off for over 22 years, with this period of time being my longest of almost 10 years. I have been on Rural Medicaid, Shared Advantage, Community Plan and Nebraska Total Care. In October 2017, you offered me a plan that I just couldn’t pass up. A plan that offered something I had been seeking from our state’s Medicaid program – a personal connection.
Nebraska Total Care is exactly what its name represents: total care. In the first month of enrollment, I had not received my program’s membership card but I had kept my enrollment information. So I called the customer service number and explained my situation, and in minutes she asked if I had computer access and helped me to get my card printed off. What I didn’t know was this call to the help desk automatically sent notice to my caseworker. By early afternoon that same day, my caseworker called me, apologized for the trouble, informed me why I hadn’t gotten my card and set up a more convenient time to talk longer about my health goals and discuss further programs available to me.
One such program is the quarterly YMCA membership. I jumped at that like it was the million-dollar lottery ticket. It has been my goal for 2018 to lose 100 pounds but I knew I couldn’t do it alone nor could I afford it on my disability income. My caseworker and I got the ball rolling for the YMCA. I started attending two classes designed for persons with disabilities. The next month, fellow class members talked me into going to the monthly potluck. My current goal is to add another group class and walk from my house in Lincoln, right around the corner from the YMCA, roughly six to 10 blocks away.
The last point I wish to convey is that my Nebraska Total Care caseworker is only required to make one check-in call per month, but in the short eight months working with her, she has become more than just my caseworker. She has become an adviser, a listening ear, a gentle voice when I feel like the world is handing me too much, and is one of my biggest cheerleaders. I’m never afraid to call her and talk to her. In fact, we usually check in about every other week with one another.
I know that Nebraska Total Care can change lives. If you need proof, just look at me.
Sarah Gilbert, Bridges Family Partner with the Cedars Youth Outreach Center in Lincoln:
I had been working with a 17-year-old new mother who moved to Nebraska from Missouri last year with the baby’s father. When that relationship ended, the young woman was homeless and slept at the mission.
Because she was a minor, the mission staff connected her with Cedars Bridges. Now pregnant with her second child, she was in need of prenatal care and Cedars Bridges assisted her in enrolling with Medicaid and choosing a plan that best met her healthcare needs.
Due to her age, however, parental consent was required before she could be enrolled in WellCare’s “Healthy Pregnancy” program. WellCare Community Relations staff worked closely with Cedars to connect with the young woman’s mother in Missouri and obtain the mother’s consent to help her daughter schedule doctor’s appointments. WellCare’s local team member also taught the young woman how to use her “Healthy Rewards” member incentive benefits and her over-the-counter medication benefits.
This young mother has made extraordinary progress in the short time we’ve worked with her, and the young woman has expressed her thanks to WellCare’s staff for helping her take good care of herself during her pregnancy.
Leo Weiler, Medicaid recipient:
UnitedHealthcare Community Plan is my health plan.
About a year ago, in July 2017, I was approved for Social Security Disability, and was later approved for Medicaid in September of 2017.
Sometime in November, I received a call from Lacey, my clinical coordinator at UnitedHealthcare. She helped me with setting up appointments. She acted as the middle person. Because I am hearing impaired, it was easier for Lacey to get involved and schedule the needed doctor visits. She also helped me to get a blood pressure monitor, dental card and a few medications.
I can handle a lot of my own. I applied for housing in September 2017, took the Rent Wise class, and received a Section 8 voucher in March 2018.
I was having a hard time getting renters to rent to me and then Sarah, the housing navigator from United Healthcare Community Plan stepped in. Sarah worked alongside me to find housing and she got me in touch with Lincoln Community Action. Sarah was able to find me a dining room table, pots, pans, cleaning supplies, towels, blankets, air mattress and other stuff from the Dollar Tree. I am using transportation called Z-Ride through Intelliride. They do a good job because they are using technology more. The driver sends me a text message about 30 minutes before a trip.
I will continue to work with Lacey and Sarah. Their compassionate acts of helping with my health and housing needs at just the right time, allows me to continue to be independent and stay healthy.
Faedah Karbouj, Medicaid recipient:
I am Faedah Karbouj. I am a mother of six children and a member of UnitedHealthcare Community Plan, Nebraska.
I have had challenging accessing much-needed health care and assistance from the community. I have terrible muscle pain and fatigue. My daughter and son live with me and help with daily needs. My son is working to finish high school.
Using an interpreter with the UnitedHealthcare Language Line, my clinical coordinator Jenny was able to help me with food assistance and support for paying utilities.
Jenny placed a conference call with the interpreter to a local food pantry to get the necessary information regarding hours and requirements. She made a number of calls to places in Omaha seeking utility assistance.
To secure utility assistance, a form from my primary care doctor was needed to document my medical necessity. I had an appointment the next day with my doctor, but did not have email to receive the form from the State representative.
Jenny offered to take the form to my house. I was very grateful. The next day when delivering the form, Jenny took time to meet with me and my daughter. My daughter assisted with interpretation. During the conversation, I shared with Jenny that I was in a car accident. I wanted to try physical therapy, but I did not know how to get it.
Jenny was also concerned about my dizzy spells, as was I. I was afraid of falling in the shower and thought a shower chair would help. She arranged for an evaluation for in-home assistance.
Jenny was a good listener and encouraged me to discuss my health issues with my doctor, and she offered to call the League of Human Dignity for waiver services.
When Jenny finished up with our visit, she called my doctor’s office to discuss some health needs, such as physical therapy, securing a shower chair to reduce the fall risk, and to make sure that the provider form for utility assistance was completed the next day during her appointment. Jenny called the League of Human Dignity to check on home and community services.
A week later, I was happy to share with Jenny that a shower chair was being delivered to the house and I had physical therapy appointment in a few days. Jenny was very interested in my doctor’s appointment and I shared that the doctor started me on an antibiotic, but the pharmacy did not have it. Jenny called the pharmacy for information on the antibiotic and called me to say it was ready to pick up. Jenny helped me with other medicines that I was taking as well. I was not taking all my medicines that my doctor wanted me to be taking.
She was so kind to update my nurse as well. Going over all the updated medicines. I had a scheduled doctor appointment for the next day and Jenny explained that the doctor would go over all of the medications I needed to get it filled at the pharmacy. Jenny suggested having my medicines delivered to me. She explained it was important to stay on my medicines and get them refilled.
Jenny got on the phone to arrange for home delivery of my medicines and they come in packs so I take the right medicine at the right time and when they will be refilled. The deliveries started the next week. I was so grateful to Jenny help me with my health and medicine needs.
I am so grateful for Jenny and the United Healthcare Community Plan. They have helped me with all of my health issues. I like to give her baked treats that I make when Jenny visits me as a way to thank her. Jenny has helped me not only physically, but also emotionally, in supporting me in my healthcare and medication needs. She has such kindness and compassion.