Investing in Quality: Medicaid Opportunities
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Transcript of Investing in Quality: Medicaid Opportunities
Investing in Quality: Medicaid OpportunitiesOklahoma Health Care Authority Board Retreat
August 27, 2009
Melanie BellaSenior Vice PresidentCenter for Health Care Strategies
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CHCS Mission
To improve health care quality for low-income children and adults, people with chronic illnesses and disabilities, frail elders, and racially and ethnically diverse populations experiencing disparities in care.
► Our Priorities Improving Quality and Reducing Racial and Ethnic Disparities Integrating Care for People with Complex and Special Needs Building Medicaid Leadership and Capacity
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CHCS Funding Partners• Aetna Foundation• Agency for Healthcare Research and Quality • The Annie E. Casey Foundation• California HealthCare Foundation• Colorado Health Foundation • The Commonwealth Fund• Kaiser Permanente• New York State Health Foundation • Robert Wood Johnson Foundation
THECOMMONWEALTH
FUND
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Medicaid’s Fast Facts
67 million People in the United States who will receive Medicaid benefits in 2009.
$364 billion Estimated 2009 costs for Medicaid.
1 million Number of additional Medicaid/CHIP beneficiaries resulting from a 1% increase in unemployment.
41% Births in the U.S. covered by Medicaid.
27% Children in the U.S. covered by Medicaid.
27% Percentage of total mental health costs financed by Medicaid.
41% Percentage of total long-term care costs financed by Medicaid.
4% Percentage of beneficiaries accounting for 50% of total Medicaid spending.
8.8 millionPeople who are dually eligible for Medicare and Medicaid, including low-income elderly and people with disabilities.
11 millionCBO estimate of additional people to receive Medicaid coverage under the House bill, with Medicaid and CHIP provisions estimated at $438 billion over the next decade.
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Medicaid’s Role for Selected Populations
Note: “Poor” is defined as living below the federal poverty level, which was $17,600 for a family of 3 in 2008. SOURCE: KCMU, KFF, and Urban Institute estimates; Birth data: NGA, MCH Update.
65%
44%
20%
51%
23%
40%
19%
20%
27%
27%
41%
24%
Nursing Home Residents
People Living with HIV/AIDS
People with Severe Disabilities
Medicare Beneficiaries
Births (Pregnant Women)
Low-Income Parents
Low-Income Children
All Children
Hispanics
African-Americans
Near Poor
Poor
Percent with Medicaid Coverage:
Families
Aged & Disabled
CHCS: Accelerating Innovation in Medicaid
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Multiple providers No coordination Lack of patient focus Inadequate information
sharing No accountability Unaligned payment
Accountable medical home Coordinated care for
patients with complex needs Patient-centered care Information exchange Performance measures Incentives/aligned financing
Fragmented Care
Integrated System
Ways States are Coordinating Care for Beneficiaries with Complex Needs
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Primary Care Case Management, Administrative Service Organizations, etc.
Alternative Models
Disease Management; Chronic Care Management; Medical Home
FINANCING OPTIONS
Care Management Approaches
Feefor
Service
Full-RiskManaged
Care
Oklahoma Medicaid’s “Learning Laboratories”
Reducing Disparities at the Practice Site ► Target small provider practices (10) with high volume of minority patients for
practice-site quality improvement► Stakeholder team includes Oklahoma Health Care Authority, Iowa Foundation for
Medical Care, and APS Health Systems
Medicaid Leadership Institute ► 12-month executive training focused on policy, technical, and leadership skills ► Position directors to maximize Medicaid’s contribution to national health system
transformation► Lynn Mitchell, MD, is in the inaugural class
Return on Investment Purchasing Institute ► Build state capacity to forecast the financial returns that may be generated by
investments in quality improvement► OK Medicaid used projected savings for people with diabetes in the Health
Management Program (HMP) to gain stakeholder support ► Currently calculating ROI for emergency room utilization program
Care Management for Complex Populations► Early innovator in development of HMP for high-need, high-cost beneficiaries
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Reform Status: House
• Tri-Committee Bill – Passed by all 3 Committees► Expands Medicaid to 133% FPL for all Americans► Individual and Employer Mandates► Insurance Exchange with Public Plan Option
• Blue-Dog Amendments► States Pay for 10% of Medicaid Expansion Beginning
in 2015► Center for Medicare and Medicaid Payment
Innovation
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Reform Status: House
• Leadership Crafting Bill for House Floor► Delicate Balancing Act between Blue Dogs and
Progressive Democrats► CBO Score Plays Vital Role► Town Hall Impact
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Reform Status: Senate
• Health Education Labor and Pensions (HELP) Committee Bill – Passed out of Committee
► Expands Medicaid to 150% FPL for all Americans► Individual and Employer Mandates► Insurance Exchange with Public Plan Option
• Finance Committee – No Bill, Only Policy Options► Gang of Six Negotiations – Deadline September 15► Exchange with Cooperatives► Unknowns - Medicaid Expansion % of FPL, and State
Share of Financing
Reform Status: Timeline
• September► House Floor Vote► Senate Finance Committee Markup
• October ► Senate Floor Vote► Conference Committee
• To Be Determined► House and Senate Votes on Conference Committee
Compromise
Reform Status: Wild Cards
• Public Opinion► “Government-Run” Health Care► End-of-Life Provisions
• Continuing Industry Support ► PhRMA Deal► AMA, AHA, AHIP, etc.
• Budget Reconciliation
Reform Considerations for Oklahoma
• Medicaid Expansion ► How Many Beneficiaries?► How Quickly?► Who’s Paying?► Movement into Exchange?
• Potential Impact on Insure Oklahoma• Medicaid (and Medicare) Financing Reform• State Role in Exchange, Public Plan or
Cooperatives
Visit CHCS.org to…
► Download practical resources to improve the quality and efficiency of Medicaid services.
► Subscribe to CHCS eMail Updates to find out about new CHCS programs and resources.
► Learn about cutting-edge state/health plan efforts to improve care for Medicaid’s highest-risk, highest-cost members.
www.chcs.org
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