IPO Roadshow

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Integration of Acute and Long Term Care Models
September 7, 2006
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AMERIGROUP Highlights

• Over ten years experience managing public sector
  programs, including ABD
• Over 8 years of experience managing an Integrated
  Long Term Care model
• Fully integrated service model integrating
  physical, behavioral, and social needs
• Emphasis on community-based services and
  promoting independence
• Encourage consumer-directed services
• Strong community support and involvement

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AMERIGROUPs SSI Membership
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Texas STARPLUS Program

• AMERIGROUP has eight years experience managing
  LTC services for the Texas STARPLUS population
  on a full-risk basis
• We have proven that Medicaid managed care will
  produce savings and improve the quality of life
  for the ABD population
• Inpatient stays decreased 28
• The number of members accessing community-based
  adult day care services increased 38
• The number of members accessing personal
  assistance services increased 32

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Eligibility for STARPLUS

• All SSI members - Mandatory enrollment of SSI
  population including dual eligibles
• 1915(c) Waiver members - SSI members and MAO
  (300 of SSI) clients in the Community Based
  Alternative Waiver
• Not in STARPLUS - SSI members not in STARPLUS
  include those in a nursing home after four
  months, MR-DD population, and other special
  1915(c) waiver groups

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Covered services for STARPLUS

• Medicaid Only
• Primary and preventive care
• Acute care
• Long term care
• Personal care services
• 1915(c) -- Community Based Alternatives Waiver
  services (skilled nursing, personal care,
  therapies, home modifications, DME, assisted
  living, adult foster care, medical supplies,
  respite, adult day health, etc.)
• Consumer-directed services
• Nursing home services for four months
• Dual Eligibles
• LTC services only (same as above)
• Care coordination with Medicare services

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Florida Nursing Home Diversion Program

• AMERIGROUP has five years experience offering
  services for elderly, dually-eligible
  beneficiaries in Florida, as evidenced by our
  Nursing Home Diversion program that successfully
• Reduces custodial nursing home utilization and
  costs through preventive care and disease
  management
• Offers a wider range of cost-effective home and
  community-based alternatives, enabling our
  members to live in comfortable, familiar
  environments and increasing member satisfaction
• Increases medical coordination and other LTC
  initiatives across the continuum
• Improves our pharmacy management service to
  members in assisted living facilities, improving
  checks for drug/drug and drug/disease
  interactions

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Florida Eligibility and Covered Services

• Personal Care Aide
• Assisted Living Facility
• Homemaker
• Personal Emergency Response System
• Chore Services
• Home Accessibility/Adaptation
• Companion
• Consumable Supplies
• Care Management
• Over the Counter Items
• Respite Care
• Financial Assessment/Risk Reduction
• Home Delivered Meals
• Nutrition Assessment/Risk Reduction
• Adult Day Care
• Nursing Home (Custodial Care)

• 65 years of age or older
• Dual Eligible
• Medicaid Eligible-Institutional Care Program
  Level up to 1692 per month and 2000 in assets
• Reside in approved counties
• At risk for nursing home placement as determined
  by CARES
• Require some help with five or more Activities of
  Daily Living (ADLs), or
• Require some help with four ADLs plus supervision
  or administration of medication, or
• Require total help with two or more ADLs, or
• Have a diagnosis of a degenerative disease or
  chronic condition requiring daily nursing service

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The AMERIGROUP Approach
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Care Coordination

• Cornerstone of the program
• Integrates primary, acute, behavioral, social,
  and long term services and supports
• Enables holistic view of members individual
  needs
• Establishes an ongoing relationship with member
• Ensures an advocate for the SSI member
• Creates a single point of contact for member and
  members family and caregivers to access services

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Care Coordination, cont

• Identify Needs
• Members contacted in first 15 days and screened
  for complex needs and high risk conditions
• Identify complex and high risk members for a home
  visit in next 2 weeks.

• Reassess and Evaluate
• Service coordinator contacts member and reassess
  the members needs and functional capabilities.
• Service coordinator and member evaluate and
  revise the service plan as needed.

Identify Needs
AMERIGROUP

• Service Plan
• Service coordinator makes home visit and conducts
  a comprehensive assessment of all medical,
  behavioral, social, and long term care needs.
• Service coordinator works with team of experts to
  develop a service plan to meet the members needs.
• Service coordinator contact the members PCP for
  concurrence.
• Member and members family reviews and signs the
  service plan.

Family Members
Service Plan
CBOs
Reassess and Evaluate

• Service Delivery
• Member selects providers from the network.
• Service coordinator works with care team to
  authorize and deliver services.
• Service coordinator ensures all appropriate
  services are authorized and delivered according
  to the service plan.

Member
Providers
Service Delivery
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The AMERIGROUP Approach Member Focused

• Service plans are designed in collaboration with
  the member
• To meet his/her goals
• To maximize independence
• To prevent avoidable hospitalizations and
  institutional care
• Individuals determine and direct their own care
  to the extent that they wish to do so
• Promotes least restrictive level of service
  possible

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Behavioral Health Services

• Provide behavioral health (BH) services through
  in-house case managers and contracted providers,
  including
• In-home visits and crisis visits for in-home
  crisis stabilization
• Coordination and support for provider
  appointments
• Coordination and support for obtaining
  medications
• Use specialty BH programs for the SSI population
  such as our Rising Star Program
• Member selects a psychiatrist
• Program promotes continuity of care
• Psychiatrist works more effectively with member
  over time, in both the inpatient and outpatient
  settings
• Favorable response by members and providers
• BH case manager is a member of the service
  coordination team to ensure an integrated system
  of care and to support the member with BH needs,
  emphasizing rehabilitation and recovery

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Community Involvement

• Partner with key community organizations,
  advocacy groups, and state and local agencies who
  serve the aged and disabled population
• Use consumer advisory panels including advocates,
  members, providers, and key stakeholders
• Involve spouses, parents, family members, and
  other important persons in the members life, as
  appropriate and desired by the member, in
  treating planning
• Provide health education, prevention, and
  outreach
• Sponsor local advocacy events and activities

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Special Activities for Members

• STARPLUS Senior Prom
• DAHS - Birthday Celebrations
• Target Hunger Food
• Clothing Drive
• Partner with Local
• Faith-Based Organizations
• Senior Groups