MOUNTAIN-PACIFIC QUALITY HEALTH FOUNDATION

FOR MORE THAN 30 YEARS, MOUNTAIN PACIFIC HAS WORKED WITH THE MONTANA DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES (DPHHS) TO SUPPORT PEOPLE WITH MEDICAID, MAKING SURE THEY CAN ACCESS THE HEALTH CARE SERVICES THEY NEED. THESE SERVICES MAY INCLUDE COVERAGE FOR DOCTOR'S VISITS, AFFORDABLE AND SAFE MEDICATIONS, PREVENTIVE CARE, AUTHORIZATIONS FOR AT-HOME OR NURSING HOME SUPPORT, MEDICAL EQUIPMENT AND SUPPLIES. WE ALSO HELP WITH TRANSPORTATION REIMBURSEMENT FOR HEALTH-RELATED TRAVEL EXPENSES. WE CONDUCT REVIEWS AND OTHER CLINICAL ASSESSMENTS TO HELP MEDICAID MEMBERS GET THE HEALTH CARE SUPPORT THEY NEED IN THE MOST APPROPRIATE AND COST-EFFECTIVE WAY. DURING FISCAL YEAR 2024, WE REACHED ABOUT 63,345 MEDICAID MEMBERS IN MONTANA AND, IN PARTNERSHIP WITH THE WYOMING DEPARTMENT OF HEALTH, MORE THAN 8,179 MEDICAID MEMBERS IN WYOMING.FROM JULY 1, 2023, THROUGH JUNE 30, 2024, OUR PRIOR AUTHORIZATION PHARMACY TEAM PROCESSED A TOTAL OF 66,679 REQUESTS WITHIN THE MONTANA HEALTHCARE PROGRAMS PHARMACY PROGRAM. THROUGH THE EXTENSIVE EVALUATION PROCESS, WE ACHIEVED SIGNIFICANT COST AVOIDANCE, ESTIMATED AT NEARLY $58 MILLION.MOUNTAIN PACIFIC'S TRANSPORTATION TEAM PERFORMS HUNDREDS OF RETROSPECTIVE AMBULANCE REVIEWS EACH DAY FOR MEDICAL NECESSITY DETERMINATIONS AND COMPLETES THE ADMINISTRATIVE REVIEWS ON ALL APPEALED AMBULANCE CASES.

UNDER CONTRACT WITH THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS), MOUNTAIN PACIFIC WORKS WITH NURSING HOMES IN MONTANA, WYOMING, ALASKA, HAWAII AND THE U.S. PACIFIC TERRITORIES OF GUAM, AMERICAN SAMOA AND SAIPAN. OUR GOAL IS TO HELP NURSING HOMES ACROSS OUR REGION PROVIDE SAFE, PERSON-CENTERED CARE FOR THEIR RESIDENTS. DURING FISCAL YEAR 2024, MOUNTAIN PACIFIC'S ACCOUNT MANAGERS PROVIDED MORE THAN 1,044 TARGETED ASSISTANCE ENCOUNTERS TO NURSING HOMES, SUPPORTING THEM IN A RANGE OF CRITICAL AREAS SUCH AS INFECTION CONTROL, VACCINATIONS, QUALITY OF CARE AND NARCOTIC DIVERSION. MOUNTAIN PACIFIC PROMOTES COMMUNITY WELL-BEING AND IMPROVED POPULATION HEALTH BY ADDRESSING THE SOCIAL, CULTURAL, ECONOMIC AND ENVIRONMENTAL FACTORS THAT IMPACT INDIVIDUALS' OVERALL HEALTH. THROUGH PARTNERSHIPS AT FEDERAL, STATE AND COMMUNITY LEVELS, WE WORK BEYOND THE WALLS OF HEALTH CARE FACILITIES TO SUPPORT BOTH PHYSICAL AND BEHAVIORAL HEALTH SERVICES. UNDER OUR FEDERAL CONTRACT WITH CMS, WE HAVE FACILITATED TWENTY-FOUR HEALTH CARE COALITIONS ACROSS OUR REGION, FOCUSING ON IMPROVING ACCESS TO SERVICES, CARE TRANSITIONS AND PATIENT SAFETY, WHILE IMPLEMENTING PAIN MANAGEMENT AND OPIOID USE BEST PRACTICES.