In this episode, I’m joined by two of my incredible colleagues, Rita Crow and Sarah Hall, as we unravel the story behind the Next Generation MyCare Program.

Welcome to "Pretend I Know Nothing." I'm Katie White, your host and the administrator of the Central Ohio Area Agency on Aging (COAAA).

Together, we’ll share how we navigated the transition from the original MyCare Ohio demonstration project to this brand new, statewide initiative. Drawing from our years of experience in case management, program leadership, and serving some of Ohio’s most vulnerable populations, we’ll give you an honest, behind-the-scenes look at all the planning, problem-solving, and teamwork that went into launching Next Generation MyCare Program.

You’ll hear how Area Agencies on Aging—like ours—play a crucial role in this work, how collaborating with managed care organizations has changed the landscape, and what it really takes to roll out a massive change like this without leaving people behind.

You don’t need to know anything about healthcare or managed care to follow along; we break it all down, and we’re excited to share what we’ve learned along the way.

Top 3 Takeaways:

1. Care Integration that Works: By uniting Medicare and Medicaid services under a single managed care plan, Ohio’s AAAs have streamlined access to care, closed coverage gaps, and delivered tailored support for some of the state’s most vulnerable populations.
2. Collaboration & Consistency Matter: Developing statewide standards—through extensive committee work and contract negotiations—has ensured that every member receives a consistent level of service, no matter where they live or which managed care plan they’re on.
3. Teamwork Powers Success: The culture of collaboration, adaptability, and putting members first sets the AAAs apart. From specialized staff roles to ongoing feedback loops, everyone works together—across units, across counties—to keep people safe, healthy, and at home.

Let me know what you think of this podcast, as well as any ideas you have for an episode. Email me at kwhite@coaaa.org!

https://creativecommons.org/licenses/by-nd/4.0/

Copyright 2026 Central Ohio Area Agency On Aging

Welcome to Pretend I Know Nothing about. I'm Katie White, your host administrator of COAAA. On today's episode, we will be discussing Next Gen MyCare.

I'm joined by Sarah hall and Rita Crow and they're going to give us the background on how this came to be, all the planning efforts that went into it, and. And how it's going. Let's get into it. All right. Welcome to the podcast. I am joined today by Rita Crow and Sarah Hall.

Rita, can you give us a little background on how long you've been here and what do you do?

Yes. While I've been here. This is my 19th year at COAAA.

I started out as a Passport case manager for about seven years, and then when my care came, I became an Aetna fully delegated case manager. From there, I became a supervisor, and then the last two years, I was clinical manager of that program.

Wonderful. So next gen, 19 years. So when's your 20th anniversary?

Wow.

Yeah. The end of next year.

Okay. And Sarah.

Rita and I actually sat together in a pod as case managers in the Passport program. And R helped me learn how to set boundaries with clients and have hard conversations. And it was a fun time. Lots of interesting conversations.

I bet it was a fun time.

I got a little taste of that before we got started today. So good. You guys cover all the topics.

I worked in the Molina program for most of the time I've been at coaa and I was the manager of that program for a handful of years. And now I am making my care happen with Rita. It's a very exciting time for us, rolling out the new program and you

guys make such a good team. I'm thrilled that we're going to get to talk to both of you today about NextGen, MyCare.

But before we talk about the big, huge, massive change that happened on January 1st, Sarah, can you give us just a brief overview of the Micare demonstration project?

So the MyCare demonstration project was pretty exciting times.

So that program targeted dual eligible individuals and included our waiver individuals in that population. They were a partnership with managed care plans.

It wasn't that Micare wasn't successful, it just needed a new vehicle. Micare actually was really successful and there is some research to say the program actually helped save the state some money.

The goals of the program was to integrate care for people who got Medicare and Medicaid. That population tends to have higher rates of chronic illness, higher minority population, a lot of health disparities.

But one of the biggest barriers is when you're receiving two insurances, there is a disconnect between the payers and things fall through the crack. So the goal with MyCare was to have all of the insurance under one managed care plan so that they could better coordinate care.

Another big goal was care coordination for the population. My care guarantee is a care coordinator, case manager, waiver service coordinator for everybody on the program.

Not all Medicaid recipients received care coordination prior to my care In Ohio. That care coordination has an advocacy component. You have a professional who's trained in the field and can help you access care.

And that was a big, big component of my care for Ohio. But mainly they really saw that there was a gap for the folks that were receiving Medicare and Medicaid.

Those folks are especially our folks who are on the waiver. Our folks meet the nursing facility level of care. They're the most vulnerable Ohioans.

They tend to be more likely to have poverty, housing instability, chronic conditions that are hard to manage. And so Ohio really wanted to make the care more coordinated and easy to access for them. And it's a win win for our population.

We are trying to keep them out of nursing facility care that's much more expensive. And we've been able to do that over the years.

So in general, when we think about the population we're serving through either the first round of my care or next gen my care. They are individuals that meet a nursing home level of care. There's financial requirements.

And essentially the waiver means that rather than going into a skilled nursing facility, they are waiving that and receiving those services in their home.

And the area Agencies on Aging in Ohio are the folks that go in, assess the need and put together the CARE plan for them and then coordinate those services. Am I getting that right, Rita?

Yes.

Okay.

That's exactly right.

So we had a couple of years to prepare, and a lot went into that preparation. So talk to me about Reed. I'm going to kick this one to you.

Talk to me about working in Aetna, which was a demonstration program, learning that things were going to change kind of, you know, what we hear. And what did we do at COAA when that information was released?

Well, we took a lot of time and the differences between Sarah's program and mine. At the time, the Aetna, my CARE program, was fully delegated.

So that meant that our case managers here took care of the Medicare and the Medicaid piece for the members. And with Sarah's Molina program, it was waiver service coordination.

So the members have a CARE coordinator at Molina and then also a waiver service coordinator here at coaa, focusing mainly on the waiver services, but partnering together.

When we learned that it was going to go away but really evolve, it was kind of an interesting time because it was a demonstration project that kept getting kicked out every three years.

With the Aetna program, out of necessity, we had evolved into a much larger program with a lot of support for not only our members, but our staff here, to help them meet the needs of their members and also meet the metrics that the state required. And we wanted to make sure that we continued that level of care not only for the members, but for the staff.

But Sarah and I, with our experience with our programs, really were able to bring that expertise together and come up with a strategic plan for how CO AAA would move forward so that we didn't have any gaps, we didn't have any members going without care, no matter what was going on with the staff. Here, we call that an integrated model of care.

I have a handout that is like a large circle with the members and their caregivers at the center and the layers outward of the support, we have here not only our waiver service coordinators, but their plan care coordinators at the plans and the support staff. We have. We have people answering the phone, we have people helping put together their service authorizations.

We have Medicaid specialists that look at their Medicaid. We have help for the staff for helping with visits. It's a really well rounded program that we wanted everyone to benefit from.

Yeah.

It also changed the way area agencies on aging are funded. So historically, we were serving clients through potentially some.

Some levy funds, doing some case management there, but mostly through the Passport program. And the PASS program is what's called a cost reimbursable program. So we do the work and we get paid back for that work.

Whereas moving into next gen, we are really now into this space where we're working with managed care organizations, which are huge organizations. And it's also risk based, meaning we are paid a certain amount of money for what we do, called a pmpm.

And we need to make sure that we're staying within that budget because if we end up spending more on our staff, we're not getting paid anymore. And so we take on kind of an additional risk of having to make sure that we're really staying within budget. So it changes the way we're funded.

And we start to come together as a state and really prepare statewide for this. So there were a ton of committees at the director level.

We were talking about legal issues and contract issues and kind of helping each other think about how we would staff up. And then even more important, there are all these other groups statewide coming together.

So can each of you tell me a little bit about some of the statewide committee work that you did?

One of the committees I worked on was committee that was really defining what the work was, defining what waiver service coordination was.

We found that really important because without a kind of definition agreed upon by both parties, the work over the years had grown and grown in scope. And that growth had caused us to have challenges in being able to meet the need.

And this partnership with a care coordinator and a waiver service coordinator only works if we have to find roles that are clear and that our folks know what their lane is, their folks know what their lane is, and they can manage the work together. So that work group met for probably a year or more to kind of define the work.

All of the contracts include that definition of waiver service coordination. And so we can go back to that contract when we're having struggles to kind of balance our workload versus theirs.

And that's been really important because it's defined and not going to continue to morph and grow. We can do staffing much more easily. We can predict how, how much staff we need based on the number of tasks and the amount of time they take.

And so that makes it a lot easier to know how much we need to hire to maintain the cases.

So you bring up such a good point about the fact that we learned so much.

Those AAA's that were involved in the demonstration project and walking into the conversations with Ohio Department of Medicaid who did this competitive process to pick the four new plans, which we haven't mentioned yet. They're Anthem, Buckeye, Caresource and Molina.

And then meanwhile, all the AAAs were working together to say, hey, when we enter into this contract, we need to be ready. We need to have clearly defined roles. We need to make sure that we're not going to be asked to go outside of our scope.

And so there were these specific work groups of folks that knew the work in and out.

And then there were also these extremely excruciating long conversations between the managed care organizations, their attorneys, the area agencies on aging and their attorneys, and literally going line by line by line on the contracts which included the scope of work and the agreed upon agency service agreement. There we go. Yep, thank you. See, clearly you were on one of the groups and making sure again that everybody agrees to it.

And in and of itself, that was something I don't think ever done before at a statewide level with four managed care organizations, everyone coming to the table and getting to a point where we all agree on something, it was massive and major.

Well, and it's really important too because we, you know, we have clients move around from plan to plan. So if the care they're receiving is very different across the state or even across.

If you move from one managed care plan to another, that was not ideal for our client population. We really wanted to have some consistency for them. For our staff, we were hoping to run a big program.

We had a lot of reasons to believe that that would be better for the members and for the staff. If we could have some consistency across the board, it would be helpful. It was very interesting. I don't think the managed care plans were in.

They weren't used to kind of dealing collaboratively together and their association kind of paired them up and negotiated things. And OFORA was involved and it was a really collaborative process.

And even ODM was involved in kind of giving final say on things and giving some guidance and direction. And there's a lot more guidance and direction for this iteration of Micare than there was for the last.

Having all of these big decision makers and, you know, for profit companies coming together and agreeing. And then there was a day where. So each area agency on aging is going to contract with all four plans.

So all four plans rolling out contracts that need to be signed on a specific day with all of their agencies on aging and going through page by page by page by page to make sure that everybody wasn't trying to sneak anything in or leave anything out. I think that was in October. It was. It was wild.

And then meanwhile there's all of that happening and then you guys are also still trying to figure out how we're going to roll that out here. So, Rita, tell me a little bit about kind of what you were doing during that time.

Well, during that time I was sunsetting my program.

That's right.

That's right.

So Aetna did not get the contract.

So we had some metrics we had to meet from the states and kind of wrapping up with our members, keeping our staff happy and knowing that they still had jobs and our members knowing that they weren't going to lose us, they weren't going to lose the care. They were. I did a lot of that during that time, having the larger program, over 3,000, almost 4,000 members at the time, working with that.

But we met, Sarah and I, along with Erica and Carrie, often about what we wanted it to look like moving forward.

Yeah. And you also did a lot of staff engagement, which I think was great too.

Not only what are your ideas and what are your challenges, but how's everybody doing? And did such a great job of bringing everyone along. You're both assistant directors for my care, but you have different roles.

So Rita, what is your role? And Sarah, what is your role?

So my role is assistant director of care and coordination, which is dealing mainly with the waiver service coordinators and the service coordinators that are doing the boots on the ground, out with the members, out doing the work so that I have more of the employees under me for that. Because that is our biggest focus. Right. Our members and what we're doing for them. So care and coordination is about that.

And yeah, the daily operations over the supervisors and working with the case assignments.

So the daily clinical operations of micare. Okay.

And then Sarah, my team is handling strategy and performance right now.

That looks like building the structure for the program and building the workflows and the cheat sheets and working with the managed care plans to make sure we get it right so we can meet members needs in their systems and in their workflows and then translating them over to to the staff. And so we have the training component on my team too. Yeah, right now we're doing a lot of building of things.

We had a lot of systems in place for MyCare 1.0, but with new managed care plans and a statement of work that's a little different. Everything has had to change. And so even the Molina program that stayed on, we've had to change many, many workflows for the staff.

And so that's been a big effort. My team has been fantastic. We have a talented group of people that love to things, they love to make things.

They're getting to create a program which I think is such a unique opportunity for them. And they've been fantastic.

And we work closely with Rita's team, especially her supervisor team, to make sure that what we are putting on paper and in process can be used in practice. And so right now we're kind of soliciting some feedback from them how things are going. Do these things actually work in practice?

So we meet at least once a month as a big supervisor group to kind of talk through. We're hoping once the dust settles a little bit to pull in the folks doing the work to give some more feedback too.

Because obviously we have a bird's eye view, but they're down and doing the work. And so they're going to have a much better idea of if what we're doing is landing well and if members needs are being met.

So kind of that feedback loop of like, okay, we hear you.

Here's how we think we operationalize it, roll it out, Tell us what's working, tell us what's not, and just continue to evolve and make it better and better. Okay, so a day in the life of a waiver service coordinator. Rita, tell us just like an overview of what that looks like.

So currently the waiver service coordinators are having case assignments in the low 60s. We did that by design because we had to make a pivot when we were putting all this together.

There was supposed to be one computer program that they were supposed to document in and that wasn't ready.

So with the four plans that we are contracted with, really three that are our main focus right now, we had to make a decision how we were going to divide up the staff.

We wanted to minimize the impact on the members so that they could keep their same case manager waiver service coordinator that they had had relationships with and minimize that impact on the staff too, because they know their caseload and it's easier to provide continuity of care when they still have their members the same. We had to pivot though, when we had three programs for them to learn to document in.

Thank goodness for Sarah and her team because they were able to, even before we were formed as a team, take the data and look at what plans the members were going with and minimize that.

I think we only had Maybe less than 30% of caseloads initially changing, but then we had to get our staff okay with learning two and sometimes three plans.

So there are some staff that are in all three plans?

Yes, some staff chose to.

Our assisted living facility service coordinators wanted that because they're in all the assisted living facilities and other staff that really wanted to minimize that, they chose to learn to work in three plans. So we have that going on. It's been a long learning process of getting trained in those three systems.

So having the lower caseloads in the beginning has been helpful for them to learn those systems and get to know their members and where they might be switching.

And they're out there doing their assessments and doing their face to face visits and making sure that these members have the personal care they need, the meals that they need, any medical equipment, the DME that they might need to keep them independent in their homes for as long as possible and partnering, then getting used to working with the plan care coordinator. So again, a lot of the staff came from being fully delegated. So they're learning these collaborations with the plan care coordinator.

And for the former Molina staff, it has changed for them too, getting used to what the plan care coordinator is responding responsible for.

So we have how many staff members in my care right now?

Approximately 138.

138. And how many consumers?

Roughly a little over 55,000. I think it's 5,200.

Wow. Okay.

So we're talking, you know, a quarter of our agency in the clinical and operational staff, plus obviously IT staff help with this fiscal staff help with this, screeners, assessors. Right. So a huge portion of our staff, of our operations, of our budget. I mean, these are multimillion dollar contracts.

Area Agencies on Aging were written into the budget so that we were guaranteed to be the waiver service coordinators. So we, so we work out all of this, all of the logistics and the insurance and the contracts with managed care organizations.

But what I think is, is so important for us to talk about is if area Agencies on Aging weren't involved in this, I feel comfortable saying that I don't know that the members would be getting as good or holistic of care. Right. So AAA's in Ohio, we know our folks, we know our communities. We're used to providing that. We've been doing it for a long time.

And when a managed care organization comes in, we also continue to have that history in the community and those boots on the grounds and the connections that are needed. So while it has been a huge undertaking and extremely complicated, I think it is so important that AAA's in Ohio are involved in this work.

We built the waiver programs in Ohio, so we have unique expertise and longevity in the field. And I think we add a lot of value to our partnership with the managed care plans.

We know the resources, we know our providers, we provide a lot of support to providers out in the field. We also have really excellent staff. We spend a lot of time and effort building up our staff in onboarding.

We are very intentional with helping them to connect with the culture and understand our mission and values. It's really important to us to give them as much training as we can to make sure they can hit the ground running.

And so we come to the table with a lot of value.

I think that managed care plans, I would assume, have been pleasantly surprised with their partnership, at least with coaa, because we take the work seriously. We're the experts in the field and we're mission driven.

We want to make sure that people can stay in their homes as long as they can, as long as it's safe with some supports. And we can be very creative in those supports and get people what they need.

And all of our staff are very in tune with what the point of the whole thing is they really know what it takes to keep someone safe in the community, and they connect with both the managed care plans and the members to do that. And I think it's really special.

I love that.

What keeps coming to my mind is, you know, when. When you have children who need help, there's lots of help out there. You know, it's already established.

But when you have an older adult who needs help, you kind of fall into that and you don't know what services are out there. That my experience has been, you know, just people. There's nothing for my mom, there's nothing for me. Yes, there is.

And, you know, to be able to just say, call the Central Ohio Area Agency on Aging, call your area Agency on Aging, they can come out and talk to you about everything that you might qualify for, and that might be helpful for you no matter what situation you're in. And I've always felt that that is such an important thing. And, you know, to be able to say in the community, just call the Area Agency on Aging.

They know it all. And we do like, like Sarah said, we train our staff not just in the waiver, but in all the resources that are out there for our members.

And, you know, Sarah and I have this program where it feels like we've got two different sides of the house, but they're meshed all the time. And that's true for this whole agency. You know, we cross paths with passport, assisted living, assessment, level of care, senior options.

You know, where I was in Fairfield county, speaking just two days ago about COAA's role in, you know, when it rolls out in Fairfield County. But it's still call us.

Yes. And it really intersects with our education and our outreach department, too. So, Sarah, you mentioned the value add.

So if COAA is case managing your individual, we also have additional support. So if there's something going on with the caregiver, we could refer over to our caregiver team. If they're housing unstable, we've got a housing team.

And so there are all of these additional pieces that working with an Area Agency on Aging brings you.

12:31 Demonstration project ends. Lights off. January 1st. Lights on. Next gen, my care starts. What was that like? What happened? Tell me about that day.

Well, it was very quiet, actually. It was pretty calm.

I was here and it was quiet.

One of the bonuses of the AAA managing the entire waiver program, rather than just pieces and parts of the waiver program is we have all the clients. They were all assigned, they have people.

And so we weren't worried about clients kind of falling through the cracks because we didn't have to do any major changes. Some of our clients went to other staff, but so we had everybody in place. We were kind of building the plane as we set off.

Unfortunately, we had gotten some training from the managed care plans back in November and December on their systems, but we did not have all the pieces and parts to make our own processes. We were waiting on information from the managed care plans on how they wanted things to go. And so we were just kind of like, hurry up and wait.

We're trying to build this thing. And. And so we had very little structure, which slowed us down a little bit. And I think that was kind of good in a way.

Instead of kind of running out there and doing visits, we had to kind of slow up and really just kind of focus on who your clients make your client list. Make sure you know who you need to reach if you need to reach someone.

And it was kind of refreshing because we thought it would be a little chaotic, but it was a little slow paced.

Yeah, I think I was definitely expecting mayhem. And Eric and I were like, we're gonna be here in case. I don't know what I would do, but I'll be here in solidarity. So, yeah, I was here.

Yeah. Yeah, me too. Yeah, it was a lot of, okay, what now?

You know, like Sarah said, get your client list together, maybe give some calls, put together, you know, get familiar in the computer systems that you're working in and, and poke around in there and take some time to just organize, go through your emails. It was kind of a nice lull for a little while.

Although one of the themes that we talked about with staff and continue to talk about with staff is it feels uncomfortable and that's okay.

And why is that?

Because it's unknown. Like Sarah said, we had structure. We had all this structure. They knew their jobs, they knew their people. They still know their people.

But knowing how to document what they needed to do in the system and what was their job versus what is on the plan. We're still trying to validate and make sure they understand. But yeah, just take your time. It's okay to be uncomfortable.

We're in the business of wanting to make people comfortable. That's why we go into this business and you know what we do with our members and try to make them comfortable. I find I want to do that with my staff.

But it's okay that we don't know all the things and it's an opportunity for the boots on the ground people to help us develop those that full circle. Helping Sarah's team with what's going on out there and what they need.

I think people were worried a little bit that they would get behind, that we couldn't start day one, that they would get behind in their contact schedule or in their documentation. But really we really stress to them like this is a learning year. We are building this thing. It's going to be okay.

We're not going to be punitive about it. Once we have the pieces in place, then we'll go back to the regular structure and regular expectations. But right now, just take a breath,

make sure your members needs are being met. Make sure there's no health safety will.

So there are some area agencies on aging that will be new to my career. Put yourself in their shoes for just a minute and what advice or what would you tell them to share with their staff or you know, my dream world.

Every area agency anti aging staff members just, you know, listening to this podcast intently. So what would you tell those new to my care folks to do to prepare?

So one of the things I'm going to tell them.

That's right, because you're leading some trainings. Thank you. Thank you.

No, well, Sarah and I are but structure matters. So it's good to have the structures in place.

But culture, reassurance and patience matter more and I think that's really important for them to take away the member experiences one system even if we have specialized roles behind the scenes. So for the member it feels seamless.

They still call the support line, they still get that help, they still have their case manager and we want that to be there. But again, structure matters. But culture, reassurance and patience matter more.

Culture, reassurance and patience. I like that. Sarah, how about you? What would you tell the new to my cares?

I would encourage them to be very flexible and open minded to go into the partnership with managed care plans with optimism. I think that there's such an easy approach to it as us versus them and so just really seeing that we are partners complement each other.

We can get a lot of great help and support from the managed care plans.

And so making sure the staff that are working most closely with those plans feel that too, they are a resource for the managed care plan and that person at the managed care plan is a resource for them. There are some challenges to working with managed care plans.

You know, we have to negotiate services through the managed care plan and get things approved. And so making sure there's a foundation of kind of trust and assuming positive intent when entering into those relationships is really important.

And remembering this is an added layer of support both for our members and for our staff.

And so the care coordinator and the waiver service coordinator can really complement each other's care and looking for those opportunities wherever possible. And just, just remembering that we're working largely with social workers and nurses at the plans. They got into this work for the same reasons we do.

Great point. They are there wanting to help members stay home and be safe in the community. And that is their motivation too.

So just keeping that front and center that that's what's happening in this relationship.

Yeah, it's a partnership and it's important because we want the same outcomes for the members and to protect that at all costs.

And so one thing that we've discussed in terms of making sure the scope of work is consistent and agreed upon, that way, no matter where you live or what plan you might be on, you're still receiving that same care. And we've talked a little bit about our staff, thinking about. Our staff are sort of plan agnostic.

Right.

Like, we know the care that we're providing and our folks on our caseload, it doesn't necessarily matter what plan that they're on. We're just, we're still consistently doing a really great job. But what does that mean in terms of building a team here?

Because previously we were like Team Aetna, Team Molina, team whatever. So tell me a little bit about what you guys referred to as one team and what that means and how you got there.

First off, I think it allows us to identify first as COAA employees rather than as like Aetna or Melina. And I think it's because staff are working across plans, it's easier for them to identify COAA employees. Again, I like that.

That's true.

I thought that that was an added perk of doing it this way. So we had a challenge because we are in three systems currently.

Eventually we will operate in one documentation system called Care Director, which has been worked on across the state. All of the AAA's gave feedback, ODM has given feedback. The plans have Given feedback, talks about

innovation and one of the a kind and amazing can't. We're so excited about that.

Well, that will allow us to more easily transition clients from plan to plan. And there is a lot of transition across insurance plans. But the waiver program itself should be a steady presence for the members.

The work we're doing with members to support their waiver needs is the same across all of the plans. And so our approach, what we didn't want was fragmentation. That's the whole point of micare, right? You're trying not to fragment.

And so the resources that we were able to give to the large program were not seen in the smaller program. And that caused challenges. We saw it a lot in our staff. But I'm sure some of the challenges also might have trickled to members.

And so we realized over time specialization has helped us to better meet member needs, better support our coworkers, and to also added bonus, get better audit marks. And so this big team approach allows us to have specialists doing pieces and parts of the puzzle.

So they're very good at it, they're consistent and it delivers better results for members.

The big one that Rita carved out years and years ago her team had carved out was service referrals and having a dedicated office or homebound staff that are at their desks doing those service referrals, troubleshooting with providers and confirming that services got started was really much better approach than having our field based staff coordinating that. It was a non clinical task so we could have specialists who knew how to do that well and were dedicated to that.

And it allowed us to really make sure people were getting their needs met thoroughly.

Like we could put the service in place quickly, call them back and make sure it started and then any problems along the way, troubleshoot that from the office rather than from your car in Licking county in between visits, trying to

make sure you don't miss the call. Tell me more about the specialized positions and how that's working.

It's working well. I think it helps minimize the gaps in care for the members too. For that very reason.

The service coordinators out in the field, making sure they take the time to follow up, they don't have to worry about that now. They send it to this team and the team manages that for them. Like Sarah said, they call and get the services started.

They have relationships with all the providers. So they might know a provider in a certain area so they can quickly get an aid to a member to make sure that they're getting their needs met quickly.

And that support has been amazing.

They also have a dedicated support line where if the members are calling in again, our waiver service coordinators are out in the field all day, all week. And we don't want members to go without getting calls.

So they can send those calls to the support line and they will call the member back and see if they can assist if it's, you know, something they can help with or if they need to refer it on or make sure, you know, it gets taken care of.

So we've got service specialists. Do they also work on dme? I know, remember at one point we had DME specialists, the dedicated support line.

You had already mentioned that there's assisted living, specialized staff. Right. They have assisted living caseloads. Any other types, transitions of care or anything?

That was a trick question.

You, you passed.

Yeah, I'm just kidding. So, so for the, the, the front facing staff, we also have our partner directed care or consumer directed care case managers who are specialized.

Do you mind just explaining what that is? Yeah.

So that's self direction.

So basically that, that's when a member wants to hire their own provider and be over the hours they get and set that they can even set the reimbursement rates for the members.

So the service specialists, the dedicated support line, the als, the self direction, do those work across all plans?

They do.

Okay.

And then we also have our service coordination team who is clinical but not licensed, and they help support the waiver service coordinators by doing face to face visits that don't require assessments.

Okay, tell me a little bit more too about like the culture piece of one team, anything that you would add to that or how you approach it or anything.

I just think, you know, being able to have the supports for everyone and makes for better outcomes for everyone.

One of the things we were able to do this time around too is, is to dedicate some woman power to really being intentional about shaping and building the program.

And so had we had to run three separate programs, we wouldn't have the staff to do the dedicated training, do the building piece that we're doing now where we have a team that works with the managed care plans to build the processes together.

What about geographically too? Like you could have one case manager out in Fairfield county and Anybody that's on waiver, they could case manage. Right.

Instead of just like one plan.

Yeah. And that was a big challenge in the outer counties.

If we had to do three plans and they were only dedicated to one plan, they might have a smaller caseload out in Delaware county, say. And then they would have to come into Franklin.

Well, I mean, we work in triads in Franklin County. It's split up, so people are regional to help keep their members together. That helps with.

With finding providers, that helps with cutting down on their time driving all over Franklin county out in the field.

And then we do have the dedicated waiver service coordinators in each county and some that can't wait for the other outer counties because we have people who drive a long way and are looking forward to having members closer to home to be able to serve.

So then that brings up the fact that the five counties that we were originally in for the demonstration project, those were the ones that shifted over on January 1st. But what about our next three counties? What's going to happen there?

They get to join the micare.

Yes, they do.

The micare, which I think, I actually think the benefits of MICARE are vast, hopefully in the care coordination part. But also just having the two insurance plans linked under one managed care plan I think is very helpful. So they get to come on in.

And when is that?

So it starts in April, but lots of the clients won't come until the summer. The department of Medicaid will send out some letters at the end of April letting people know that they are now eligible for MyCare Ohio.

And here's your managed care plan. If you fail to pick a managed care plan, you'll be on this one. But if you'd like to pick, pick one, you can do it these two ways.

And so people will be picking managed care plans starting probably in April through July.

Okay.

And so for our program, we. We anticipate growth of just a little under, what, 2,000 clients, was it, Rita?

I was saying 2,000.

Yeah, because we'll gain Fairfield, Licking and Fayette counties.

Not all at once, though, you're saying. And they'll kind of slowly transition over.

The three counties will come out at the same time.

But all 2,000 members. Right.

Okay. I anticipate, but I don't know this to be true.

I anticipate a trickle for those first few months after April and then all of them coming in July, but I don't know that to be true.

Okay.

We are hoping to get some advanced information from the Department of Medicaid to Kind of help us with staffing and to kind of predict what we're needing. We're looking at that, that stuff now and kind of thinking about what makes sense for how many members to staff and that kind of thing.

And so we're looking at it now, but we should have some concrete numbers starting in the spring.

And obviously we focus today, like on our lens and our experience through next gen my care.

But ODM has been through a ton of work and change and they're, you know, rolling things out as quickly as they can, but they're also having to kind of build the plain while it flies. It's new for some of the many managed care organizations how this is all working.

And so the fact that for the most part, knock on wood, things are rolling out and working and pretty steady is incredible.

Right?

I mean, not that I want to borrow trouble, but it just, it seems pretty awesome that how we've been able to do this.

Cleanliness.

Yeah, a lot of those safeguards were put in place. You know, weekly meetings, sometimes daily meetings with the plans, with ODM, with 04A.

So the state in general, the plans, the state ODM, we're all talking and making sure that people aren't falling through the gaps. And again, no one is falling through the gaps because we know our clientele.

But as far as making sure that they're with the plans and getting the services they need, that's one of the

unique values we add to the puzzle is that we do have the entire MyCare census for the over 60 population. So we can easily see, huh. This managed care plan gave us a list of their members, but seems light.

So that would mean like, we've got this whole list because we've been working with them and then we get the list from each of the plans and we're like, ooh, there's like 200 people missing or something like that. But we know and we can keep that continuity and figure it out.

Right. And we also see. So someone might pick a managed care plan mid month and then be backdated. There's a lot of insurance movement.

And so because we have the whole population working with our staff, people don't just drop off our radar, they stay with us and so they might drop off the insurance company's radar, but we still have them in the mix and we can get them over to the right insurance company when needed.

We had 10 years of experience.

We pulled together staff not only from rlea, but from all over the state and were able to use that experience to really advocate for some key pieces and points that were very important for the member, best for the member and also good for staff. And those ended up in the scope of work.

So I just want to make sure that we're highlighting how our experience and then our advocacy has led to what I think is this, you know, amazing next gen plan. And before we close out, I'm sure you won't take credit for yourselves but brag about some of the work we've done, some of the cool things.

Some of the staff members like take a minute and just like brag about points of pride in making all of this happen.

Well, I'm proud of our whole staff.

What they've been, you know, all the pivots we've had, that was our theme for a lot of months is like, yep, we're going to pivot and that's, you know, and we will pivot again if we need to. And they seem open to that. I know.

I'm so proud of them for learning multiple systems at once, maintaining member centered focus during all this uncertainty, under all this uncomfortableness, they still keep their members as their central focus. And we've been as transparent as we can be. Transparency is very important. So we want to remain transparent and have open forums.

I really am seeing now, I mean we're just 6ish weeks into this, but as the staff gets out in the field and is working in these systems, I'm seeing confidence grow and I just am really proud of them for that.

They've had incredible adaptability going out into the unknown and mostly very positive attitudes. And we are trying to be transparent, which means we sometimes are, you know, putting it out there. This is what we're going to do. This could change.

We're going to, you know, be as careful and plan as much as we can. But we are building the plane as we take off and there's going to be rough patches and mainly people have been really accepting of that.

I think the supervisor team has been really great. A lot of them have spent a lot of time working with the managed care plan to understand what we need to do to get the members needs met.

A lot of creativity in making processes work for our team and making sure we keep the member focused. Meet those needs as much as possible.

And both of you, your leadership and your dedication to this, I mean, I know it was countless hours, like you said, you were sunsetting a program while building a program, while planning something, while being on these scope of work meetings, working with the attorneys. I know how much time and energy and effort went into it. And just a huge kudos to both of you.

I'm obviously biased, but I feel like the way that you all have created and rolled this out and operationalized how we're making, making a lot of decisions is just, it's a model to be looked at for sure.

Thank you, Katie. Thank you, Katie.

Yes.

Thank you for your support working with the AAA's across the state to make this happen. I just think it's so important for us to shape the programs we're running.

And I think we really did that with MyCare NextGen and I'm really happy with the results.

Yes.

And we couldn't do it without Erica and her support of us as well. Erica and, and even Carrie Oswald. We kind of have a crackpot team together and thanked Erica for all her support.

And you mentioned culture earlier and I've been at COAAA for 19 years and I've always said the culture here is none other than anywhere else I've worked because I had a lot of years experience before I came here at 19 years. But I, I have a closing thought of transitions test organizations, but culture determines whether you fracture or grow stronger.

And I'm proud to say our team, not just our team with MyCare, but this whole COAAA team, has chosen growth. And I thank you for that, for being at the helm of that. I thank Erica for that. We're so glad to have her as our fearless leader too.

Well, that's a perfect place to end. Thank you both so much. I hope now you know something about Next Gen MyCare.