Aetna Medicaid Overview
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Transcript of Aetna Medicaid Overview
Aetna Medicaid
Aetna MedicaidOverview
Long Term Services and SupportsAugust 2013
Aetna Medicaid
Medicaid Overview
Core business is serving TANF/ CHIP/ ABD/LTSS with a focus on serving high acuity populations
Post Coventry acquisition we have grown to ~2.2 million members across 16 states
Recent awards validate the strength of our integrated care expertise and ability to effectively manage high acuity populations Duals programs in Ohio, Illinois and New York LTSS programs in Illinois, Delaware and New York Behavioral Health/SMI award in Arizona
Aetna and Coventry Existing Medicaid Markets
Populations Served TANF: Temporary Assistance for Needy Families CHIP: Children’s Health Insurance Program ABD: Aged Blind Disabled LTSS: Long Term Services and Supports Duals: Members eligible for both Medicaid and Medicare BH/ SMI: Behavioral Health/ Seriously Mentally Ill
(Recently awarded Arizona contract)
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Aetna is a leader in managing medically complex populations at the local, community-based level by integrating physical health, behavioral health and social economic status of members
Aetna States
Coventry States
Shared States
Aetna Medicaid
Introducing a Key Issue…
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Aetna Medicaid
Aetna Medicaid Model of Care and Capabilities
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Aetna Medicaid
Aetna’s Model of Care - Integrated Care Management
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Received “recognized” 96.4% of 100% score
Focuses on members with a lower complexity profile with less risk for future utilization but with an immediate presenting issue
low risk profiled members and specific contractually-required populations
RISK
High
Low
IntensiveCare
Manageme
nt
StandardCare
Management
Service Coordination & Support
Population Health Services
Member centered approach & focus on community relationships integrating physical health, behavioral health and social economic status of members
Focuses on high-risk vulnerable members characterized by bio-psycho-social complexity. Care managers address the root causes that drive poor health, within the context of a longer term working relationship with the member
Aetna Medicaid
Goal: Decrease Fragmentation and Improve Coordination of Care
Working with Members All members assigned to CM, member centered approach CM assess members in multiple settings including home, assisted living
facility and nursing facilities -- helps drive quality Responsible for managing entire member through integration and
coordination of care Medical: Hospital Discharge, PCP Visits, DME, PharmacyFunctional: In-home Care, Assisted Living, Nursing FacilityBehavioral Health: Full array of BH services carved in
Special Care Management teams for behavioral health and medically complex recipients
Drive member action – vaccinations, PCP visits
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Aetna Medicaid
Local Integrated Support of Members in their Community
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Aetna Medicaid
Effective Use of Home and Community Based CareALTCS Trend HCBS Utilization
'89 '91 '93 '95 '97 '99 '01 '03 '05 '07 '080
102030405060708090
100
HCBS
SNF
MCP LTC HCBS
Governor’s Report to Senate
Perc
enta
ges
%
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Aetna Medicaid
Medicaid LTSS Users Accounted for Nearly Half of Medicaid Spending, 2010
NOTE: Individuals who used both institutional and community-based services in the same year are classified as using institutional services in this figure. SOURCE: KCMU and Urban Institute estimates based on data from FY 2010 Medicaid Statistical Information System (MSIS). Because 2010 data was unavailable, 2009 data was used for Colorado, Idaho, Missouri, and West Virginia.
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Capitated Medicaid Managed LTSS: An Emerging TrendCMS reports that more than half the states are expected to be operating capitated
Medicaid managed LTSS programs by January 2014, including:
Expansion of current Medicaid capitated managed LTSS programs under § 1115 or § 1915(b)/(c)
19 states with waivers implemented or approved as of 2012 (AZ, CA, DE, FL, HI, KS, MA, MI, MN, NH, NJ, NM, NY, NC, PA, TN, TX, WA, and WI)
Establishment of new Medicaid capitated managed LTSS programs under § 1115 or § 1915(b)/(c)
3 states with proposals pending (CA, IL, and NV)
Implementation of Medicare/Medicaid financial alignment demonstrations for dual eligible beneficiaries under § 1115A combined with § 1115 or § 1915(b)/(c)
5 states with capitated proposals approved (CA, IL, MA, OH, and VA); 10 states with capitated proposals pending (HI, ID, MI, NY, OK, RI, SC, TX, VT, and WA)
SOURCES: P. Saucier, J. Kasten, B. Burwell, and L. Gold, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012, available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/MLTSSP_White_paper_combined.pdf; M. Musumeci, Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: California, Illinois, Massachusetts, Ohio, and Washington, The Henry J. Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, May 2013, available at http://www.kff.org/medicaid/issue-brief/illinois-massachusetts-ohio-and-washington-financial-alignment-demonstrations-for-dual-eligible-beneficiaries-compared/.
Aetna Medicaid
The New Health Care Landscape is Emerging…
New and Innovative Relationships Increased focus on innovative care management models for high-risk
populations across the community care continuum
Value-Based Payment Models Demand for value-based purchasing arrangements focused on
achieving quality outcomes: pay for performance, shared savings, bundled payments, alignment of quality incentives
Health Information Technology Alignment Intense focus on health information technology as key driver for care
coordination and point-of-care delivery optimization
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Aetna Medicaid
Home Care or Nursing Facility
Care Coordination of the Future
Care Coordinat
or
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Aetna Medicaid
Aetna Solutions: The Role of Technology
Clinical Data Integration Secure Data Exchange
Real time provider interface Application Store Rapid Distribution
Population based clinical intelligence Decision support Care management
Popular mobile based application User (symptom) to provider link Appointments, registration, alerts, cost
Health Information Technology Alignment - focus on health information technology as key driver for care coordination and point-of-care delivery optimization
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Aetna Medicaid
A Partnership for the Future…
An Integrated System
The Right Experience
The Right Perspective
The Right Technology
The Right Results
High Quality
High Satisfaction
Aligned Stakeholders
Future Focused
Cost Savings
Thank You!14