AMCCI Provider Program overview
Alaska Department of Health & Social Services: Summer Update 2014
newsletter contains an article entitled:
New initiative aims to reduce health care spending on ‘super-utilizer.’
The Division of Health Care Services (Division) is excited to announce its new program, The Alaska Medicaid Coordinated Care Initiative (AMCCI). It is designed to assist members to navigate the health care system and appropriately use the benefits of the Alaska Medicaid program.
DHCS has identified Alaska Medicaid members that used a higher number of medical visits (including emergency room) than other members. To identify members that may benefit from the AMCCI program, the Division examined Medicaid claims data for members who used the emergency room five or more times during an 18-month review period. The Division identified more than 6,000 individuals who met the criteria. Caring for members who use hospital emergency room services significantly more than the general Medicaid population, accounts for 3 percent of the Alaska Medicaid population. But these clients, called super-utilizers, are responsible for approximately 22 percent of all Alaska Medicaid emergency room expenses.
DHCS is actively seeking member volunteers to participate in the AMCCI.
The aim of the AMCCI is to provide personalized one-on-one attention and case management services to members. Case managers will assist members to coordinate their care in collaboration with their medical providers. At the beginning of the AMCCI program, participants will select a primary care provider (doctor, nurse practitioner, or physician assistant), a hospital, a pharmacy, and if appropriate, a behavioral health provider who will work with the case manager and the member to manage their care. Members may also choose to keep their current providers. If you would like to refer any of your patients who are Alaska Medicaid members and whom you think would benefit from this program, please complete the AMCCI Member Referral form.
Please continue to monitor this website for additional information as the program develops. Thank you for your interest in the AMCCI.
Alaska was one of six states and one territory – Colorado, Kentucky, New Mexico, West Virginia, Wisconsin, and Puerto Rico- selected by the National Governors Association (NGA) in the summer of 2013 to develop an action plan to serve the Emergency Room Super utilizers’ health needs more efficiently and cost-effectively. Recently the NGA held an in state retreat to provide technical and work plan assistance to DHCS staff.
In order to better assure appropriate use of medical services, improved health outcomes, and better control increasing Medicaid costs, the state Division of Health Care Services is undertaking a 24-month project. The Alaska Medicaid Coordinated Care Initiative (AMCCI) will provide case management and care coordination for this group to members.
The Division’s Quality Assurance Unit team has issued an RFP for case management services, which will be awarded during the summer of 2014. The implementation of case management services is targeted to begin during the fall of 2014.
The initiative will serve recipients of Alaska’s Medical Assistance program, which includes Medicaid, Denali KidCare, Chronic and Acute Medical Assistance, and other programs. Initiative goals include reduction of emergency room visits, improved use of preventive services, comprehensive case management and care coordination, and integration of medical care and behavioral health services.
Once awarded, the selected vendor(s) will provide case management services that will be individualized to each member’s medical needs. The case manager will interact with the medical providers and perform a medical record review to better understand the care each member has received. After gathering information from the member and their providers, the case manager will work with each member to develop a plan of care. Members will also receive case management services such as scheduling appointments, addressing problems, and getting referrals to specialists. Case managers will work directly with the member and their health care providers to get their health care and the support they need.