Slide 1: Tufts Health One Care Flexible Benefits April Implementation Council

Tufts Health Plan | Cityblock

April 2024
Slide 2: Agenda for Today’s Discussion
1.	Overview of Tufts Health One Care Flexible Benefits (3 minutes)
2.	Tufts Health One Care Flexible Benefit Approval Process (4 minutes)
3.	How Members Learn about Flexible Benefits (3 minutes)
4.	Quantitative Impact of Tufts Health One Care Flexible Benefits (2 minutes)
5.	Overview of Cityblock Member Spend Program (3 minutes)
6.	Cityblock Member Spend Approval Process (3 minutes)
7.	Quantitative Impact of Cityblock Member Spend Program (2 minutes)

Note: the following footnote appears on this slide and all other slides going forward. “Proprietary & Confidential”
Slide 3: Overview of Tufts Health One Care Flexible Benefits
•	All One Care plans offer Flexible Benefits, which provide coverage for innovative services and supports that are outside One Care’s defined benefits but promote improved member health. Flexible Benefits empower each member’s care manager to be creative in how they deliver person-centered care that meets each member where they are. 
•	Members are informed about Flexible Benefits from their interdisciplinary care team. Care managers participate in annual One Care trainings where they learn about this benefit, which is unique to the One Care model. 
•	Care team identified Flexible Benefit requests are sent for approval to a monthly medical director’s meeting that is comprised of the following representatives: 

1.	Tufts Health One Care medical director
2.	Cityblock medical director
3.	Cityblock care management staff
4.	Tufts Health One Care utilization management staff 
5.	Tufts Health One Care director of product strategy
Slide 4: Tufts Health One Care Flexible Benefit Approval Process 
Note: the following items are shown in a flowchart within shaded rectangles with arrows pointing from one to the next.

•	Need is identified by member’s care team during any interaction
•	Request submitted on behalf of member by their care team
•	Request reviewed at next monthly medical directors meeting
•	Request approved by medical director and director of product strategy?
o	Dual approval by the medical director and director of product strategy ensures that flexible benefits are approved based on individual member medical considerations and general fit with the care model. 
Note: the arrows point to two scenarios.
•	Yes - Care team follows up with member to complete the request
•	No - Explanation of decision sent to care team and member OR more information requested

Requests evaluated based on:
•	The expected health benefit of the Flexible Benefit 
•	Whether a covered service meets the request 
o	During 2022 to 2023, all Flexible Benefit requests were approved.
•	Whether the care team has provided all of the necessary context for the request
Slide 5: How Members Learn about Flexible Benefits
•	Tufts Health One Care members can learn about Flexible Benefits in their Member Handbook, which is available on the Tufts Health One Care website. 
•	Tufts Health One Care members also learn about Flexible Benefits from their care managers during assessment or ongoing care planning, who may suggest Flexible Benefits based on members’ individualized care plans and will assist members in submitting Flexible Benefit request. 
•	One Care plans, including Tufts Health One Care, do not currently report information regarding Flexible Benefits to EOHHS. Tufts Health One Care would be happy to participate in a cross-functional work group to explore how to best track and report flexible benefits utilization to EOHHS. 
Slide 6: Overview of Cityblock Member Spend Program 
•	Although separate from Flexible Benefits, Cityblock operates a member spend program that similarly seeks to provide members with services or items that can impact their health.
•	Tufts Health One Care members may receive both Flexible Benefits from their health plan and assistance through Cityblock’s member spend program.
•	For example, a member may receive a new air-conditioning unit or advanced air filtration system as a Flexible Benefit and receive replacement filters for the unit through the member spend program. 
•	Cityblock has a $75 per member per year limit for the member spend program.
Slide 7: Cityblock Member Spend Approval Process  
Note: the following three items are shown in shaded rectangles with arrows pointing from one to the next. The note about care managers’ annual training is in a separate rectangle off to the side.
 
1.	Cityblock care managers learn about member’s health goals and educate members on member spend when and if a need arises. 
2.	If a member spend program request is identified, Cityblock care managers work with their supervisors and operations team to track and approve the request.
3.	Cityblock care managers use approved funds to deliver the item or service to the member. 

Cityblock care managers receive annual training on flexible benefits and the member spend program.
Slide 8: Quantitative Impact of Cityblock Member Spend Program

Note: the following information is shown in bar graphs on this slide.

Number of Enrollees Receiving Member Spend Benefits
2022: 44
2023: 104
Total=148

Amount Spent on Member Spend Benefits
2022: $1,072
2023: $2,612
Total=$3,684

Slide 9: Thank you!