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![Page 1: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/1.jpg)
New Approaches to State Health New Approaches to State Health Reform: Extending Coverage to Reform: Extending Coverage to
the Uninsured and Reducing the Uninsured and Reducing State Health Care CostsState Health Care Costs
Julia M. Eckstein, Director
Missouri Department of Health and Senior Services
![Page 2: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/2.jpg)
3 Topics
• Medicaid reform
• Health improvement
• Uninsured
![Page 3: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/3.jpg)
MO Environment
• New Governor in 2005
• Government Review Commission
• Budget challenges
• 3 Departments deal with Medicaid
• Health status
![Page 4: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/4.jpg)
Senate Bill 539• Modified certain provisions dealing with various
health care and social service programs, including:– Medicaid– Missouri Senior RX– Personal care assistance programs– Nursing Home Facilities– Medicaid Reform Commission– Adoption Subsidy– Sunset current Medicaid program
– http://www.senate.mo.gov/05info/BTS_Web/Bill.aspx?SessionType=R&BillID=22520
![Page 5: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/5.jpg)
Medicaid Reform CommissionMedicaid Reform Commission• Created under Senate Bill 539, 208.014 RSMo,
and Senate Concurrent Resolution 15 (2005)• Membership included 5 members of the House of
Representatives & 5 members of the State Senate• Directors of the Department of Health and Senior
Services, Department of Social Services and Department of Mental Health serviced as ex-officio members
• http://www.senate.mo.gov/medicaidreform/MedicaidReformCommFinal-122205.pdf
![Page 6: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/6.jpg)
The ChargeThe Charge• Recommend a fundamental program that
achieves:– Improves the health status of Missourians by
increasing access to basic healthcare, wellness and prevention.
– Better identifies the needs of participants and develops services that meet those needs & results in the best outcomes at the best cost.
– Ensures appropriate levels of statutory and administrative oversight to improve participation & efficiency by providers while improving access to quality care.
![Page 7: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/7.jpg)
• Charge continued
– Provides service options that will encourage the least restrictive setting for the delivery of care, especially as it relates to long-term care.
– Ensures the state budget lives within its means by controlling the financial growth of the public healthcare program and fully utilizing and encouraging the use of private insurance
– Focuses resources to help those with the greatest need and provides taxpayer resources only to those who cannot afford to provide for themselves.
![Page 8: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/8.jpg)
• Charge continued
– Identifies and makes recommendations to eliminate waste, fraud and abuse in Missouri’s public healthcare system as it relates to those getting services and those providing services.
– Consolidates as appropriate and administers state medical assistance programs to achieve maximum efficiency and effectiveness.
![Page 9: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/9.jpg)
Public Hearings• 21 meetings covering:
– Medicaid Overview & the current program– Availability and eligibility– Hospital's perspective– Technology in healthcare– Long-Term Care– Medicaid Reform in other states– Medicaid and managed care– Provider’s perspective– Pharmacy– Mental Health
![Page 10: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/10.jpg)
Medicaid in Missouri• Began offering health coverage to low-income
individuals in 1959.
• Missouri’s Medicaid program under Title XIX of the Social Security Act began in 1967
• FY 92:
– 462,090 participants
– $1.35 billion
• FY 05:
– 992,622 participants
– $5 billion
![Page 11: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/11.jpg)
![Page 12: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/12.jpg)
Medicaid for the 21st Century
• Risk
• Responsibility
• Reward
• Transparency
• Availability
• Technology
![Page 13: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/13.jpg)
Reform Focus Areas• Wellness, prevention and responsibility• Provider participation and satisfaction• Managed Care• Technology• Mental Health• Long-term Care• Pharmacy• Availability of quality care• Eligibility
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Where are we headed?
![Page 15: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/15.jpg)
Shifting DemographicsAmerica’s population over 65 will be America’s population over 65 will be
double by 2020.double by 2020.
By 2025, 1 in every 5 Missourians will be By 2025, 1 in every 5 Missourians will be 65 or older65 or older
Within 8 years America’s 77 million baby Within 8 years America’s 77 million baby boomers will begin turning age 65.boomers will begin turning age 65.
Only 18% more workers to support them.Only 18% more workers to support them.
![Page 16: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/16.jpg)
Aging Population
An aging population is already straining our safety net healthcare programs. In Missouri, 70% of Medicaid is spent on the elderly and disabled.
![Page 17: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/17.jpg)
What do we know?
![Page 18: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/18.jpg)
Factors That Impact Health Status
50%
10%
20%
20%
Lifestyle/Behavior
Environment
HumanBiology/Genetics
Medical Care
![Page 19: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/19.jpg)
Individual Responsibility
In the past the major causes of disease were out of the individuals’ control. Today, most health issues are avoidable or can be minimized by individual action. Each individual is his or her best “doctor.”
![Page 20: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/20.jpg)
Chronic Illness
80¢ of every health care dollar is spent on chronic disease.
DHHS
![Page 21: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/21.jpg)
The question is NOT how do we deliver health care to 300 million Americans,
it is how do we keep America HEALTHY?
![Page 22: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/22.jpg)
MOve to Improve:MOve to Improve:Creating a Culture Creating a Culture
of Healthof Health
![Page 23: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/23.jpg)
DHSS Vision
Healthy Missourians for Life
![Page 24: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/24.jpg)
DHSS MissionDHSS Mission
To be the leader in promoting, protecting
and partnering for health.
![Page 25: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/25.jpg)
![Page 26: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/26.jpg)
Increase Missourians’ Increase Missourians’ Awareness of, Awareness of,
Commitment to & Commitment to & Investment in HealthInvestment in Health
![Page 27: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/27.jpg)
Shift the Focus Shift the Focus Toward Prevention & Toward Prevention &
WellnessWellness
![Page 28: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/28.jpg)
Create System Level Create System Level Transformation of Transformation of
Health Improvement & Health Improvement & Health Care DeliveryHealth Care Delivery
![Page 29: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/29.jpg)
Use Policy as Use Policy as a Toola Tool
![Page 30: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/30.jpg)
DHSS GoalsDHSS Goals
• Missouri Markets Health
• Missouri Motivates for Health
• Missouri Models Health
![Page 31: New Approaches to State Health Reform: Extending Coverage to the Uninsured and Reducing State Health Care Costs Julia M. Eckstein, Director Missouri Department.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649f575503460f94c7cbb2/html5/thumbnails/31.jpg)
Current Work/Current Work/Next StepsNext Steps
• Uninsured • Executive Branch Medicaid Work
Group• Implementation of Strategic Plan• Legislative support of and
investment in health.