“THE OTHER” IMPACT OF EXPANSION Franklin Smith, CRCE-I Kristina Mori, CRCE-I September 16, 2015.
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“THE OTHER” IMPACT OF EXPANSION Franklin Smith, CRCE-I Kristina Mori, CRCE-I September 16, 2015
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Transcript of “THE OTHER” IMPACT OF EXPANSION Franklin Smith, CRCE-I Kristina Mori, CRCE-I September 16, 2015.
“THE OTHER” IMPACT OF EXPANSIONFranklin Smith, CRCE-IKristina Mori, CRCE-ISeptember 16, 2015
Goals and Objectives2
Examine the impacts of Medicaid expansion on the financial health of hospital operations
Provide evidence of hospital system participation in population health management
Discuss how Maryland’s Waiver defining market share works against rural facilities managing care
Provide potential solutions to some of the unique waiver issues created by Medicaid expansion
Population Health Initiatives vs MD Waiver Governance
Just what the heck does population health mean
Wide variety of definitions, with accountability serving as the connector
David Kindig and Greg Stoddart started it stating “the health outcome of a group of individuals, including the distribution of such outcomes within the group.”
Definition lacked how to achieve the best results utilizing healthcare institutions
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Richard Pizzi’s Leadership Groups definition
as an opportunity for health systems, agencies and organizations to work together in order to improve the health outcomes of the communities they serve
Source: Society of Hospital Medicine
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Medicaid Percentage Change States Approving Expansion on the East Coast
Source: http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/
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States Not Participating in Medicaid Expansion on the East Coast
Source: http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/
Additional Medicaid Expansion Facts
Sources: http://avaler.com and http://obamacarefacts.com
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8 million Americans enrolled in Medicaid or CHIP since ACA and state sponsored expansion
The net increased of insured is estimated to exceed 6 million when those who lost eligibility are included
The working poor benefited the most, as most of the nation’s poorest were covered previously
Non-expansion states Medicaid enrollment increased by 10% due to the Woodwork Effect
Woodwork Effect are previously eligible subscribers who enrolled as a result of increase awareness
Studies Tracking Enrollment by Coverage Type since ACA Launch7
Source: obamacarefacts.com
Payer Mix has Changed with Medicaid Expansion
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Maryland’s Payer Mix is No Different than the Country’s Changes9
• Decrease in Self Pay is consistent with the trends around the country for expansion states
• Overall seems Marylanders have not shown a preference of MCO or straight Medicaid
• All other payers were basically flat for inpatient services during the periods studied
PayerGroupinig
Total $s % of $sWorkers Comp 18,666 1% 20,509 1% 17,206 1%Self Pay 158,186 5% 95,575 3% 83,005 3%Commercial 663,911 21% 696,133 22% 702,632 23%Medicare 1,182,562 37% 1,131,336 36% 1,131,673 37%Medicaid 207,466 6% 186,746 6% 203,211 7%MCO 253,917 8% 297,221 9% 287,938 9%Managed Care 256,287 8% 248,639 8% 207,624 7%CareFirst 484,962 15% 481,380 15% 439,221 14%
Grand Totals 3,225,957 100% 3,157,539 100% 3,072,510 100%
Total Revenue Per Quarter2013 Jan-Mar 2014 Apr-Jun 2015 Jan-Mar
Maryland’s Payer Mix is No Different than the Country’s Changes10
PayerGroupinig
Total $s % of $sWorkers Comp 8,433 1% 9,226 1% 8,237 1%Self Pay 85,572 7% 57,549 4% 49,976 4%Commercial 292,124 23% 327,710 24% 314,978 25%Medicare 371,164 29% 403,784 29% 363,979 29%Medicaid 56,277 4% 64,663 5% 70,202 6%MCO 119,177 9% 147,707 11% 126,401 10%Managed Care 121,311 9% 122,700 9% 100,915 8%CareFirst 236,121 18% 242,189 18% 213,317 17%
Sub Totals 1,290,179 100% 1,375,528 100% 1,248,005 100%% of Total Rev 40% 44% 41%
Outpatient Revenue Per Quarter2013 Jan-Mar 2014 Apr-Jun 2015 Jan-Mar
PayerGroupinig
Total $s % of $sWorkers Comp 10,233 1% 11,283 1% 8,969 0%Self Pay 72,614 4% 38,026 2% 33,029 2%Commercial 371,787 19% 368,423 21% 387,654 21%Medicare 811,398 42% 727,552 41% 767,694 42%Medicaid 151,189 8% 122,083 7% 133,009 7%MCO 134,740 7% 149,514 8% 161,537 9%Managed Care 134,976 7% 125,939 7% 106,709 6%CareFirst 248,841 13% 239,191 13% 225,904 12%
Sub Totals 1,935,778 100% 1,782,011 100% 1,824,505 100%% of Total Rev 60% 56% 59%
Inpatient Revenue Per Quarter2014 Apr-Jun2013 Jan-Mar 2015 Jan-Mar
• Expansion has not impacted the inpatient outpatient split for these periods
• Carefirst and Managed Care plans lost payer mix to commercial payers based on revenue percentages
• Using classes with changes greater than 1 point, an additional $135 million ($72.9 IP, $62.4 OP) will need to be protected through RCM operational changes to preserve financial reimbursement
Utilization Patterns Since ACA
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Source: MHA Financial Condition Reports
Totals based on 9-months ending in March of each year
Many drivers to reduced inpatient days (observation, value reimbursement)
Trend of reduction projected for next 9 month period
Utilization Patterns Since ACA
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Source: MHA Financial Condition Reports
Totals based on 9-months ending in March of each year
Population health measures not effecting ER use
New patients from Medicaid Expansion using ER due to access barriers
Utilization Patterns Since ACA
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Source: MHA Financial Condition Reports
Totals based on 9-months ending in March of each year
Hospital examination of regulated vs unregulated settings
Hospitals utilize OP Clinics to manage care versus PCP
Projected Needs of PCPs for MD according to Robert Graham Center
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MD Hospital Financial Condition Report 9 Months Ending Look15
Source: Maryland Hospital Association
Population Health Initiatives Relationship with MD Waiver
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Population Health Initiatives Relationship with MD Waiver
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Population Health Initiatives Relationship with MD Waiver
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Population Health Initiatives Relationship with MD Waiver
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Suggestions and Potential Responses to Issues Identified
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Suggestions and Potential Responses to Issues Identified
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Suggestions and Potential Responses to Issues Identified
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Suggestions and Potential Responses to Issues Identified
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Conclusions
Financial and clinical integration is crucial to seamless population management
Medicaid expansion and the ACA has had an impact on the financial conditions of the state’s healthcare system
Maryland hospitals and their advocates must continue to innovate and tinker with waiver rules to accommodate for provider services
ICD-10 and tighter payer coverage edits will require connectivity to HIE services to query and communicate with providers
Strong partnerships with physician and ancillary healthcare providers to meet patient needs through a coordinated effort to maximize return on invested dollars.
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Adversity is wont to reveal genius, prosperity
to hide it.
HoraceHorace
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Questions
Contact informationMr. Franklin Smith, Jr.,
Director, Patient Financial Services
Calvert Memorial Hospital
Phone 410.535.8259
Email: [email protected]
Website: www.calverthospital.org
Ms. Kristina Mori
Manager, Patient Accounting
Calvert Memorial Hospital
Phone 410.414.4802
Email: [email protected]
Website: www.calverthospital.org
