Investing in Quality: Medicaid Opportunities

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Investing in Quality Medicaid Opportunities

• Oklahoma Health Care Authority Board Retreat
• August 27, 2009
• Melanie Bella
• Senior Vice President
• Center 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

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Medicaids 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 million People who are dually eligible for Medicare and Medicaid, including low-income elderly and people with disabilities.
11 million CBO 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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Medicaids Role for Selected Populations
Percent with Medicaid Coverage
Families
Aged Disabled
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.
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CHCS Accelerating Innovation in Medicaid
Integrated System
Fragmented Care

• 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

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Ways States are Coordinating Care for
Beneficiaries with Complex Needs
Fee for Service
Full-Risk Managed Care
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Oklahoma Medicaids 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 Medicaids
  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

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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

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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

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Reform Considerations for Oklahoma

• Medicaid Expansion
• How Many Beneficiaries?
• How Quickly?
• Whos Paying?
• Movement into Exchange?
• Potential Impact on Insure Oklahoma
• Medicaid (and Medicare) Financing Reform
• State Role in Exchange, Public Plan or
  Cooperatives

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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 Medicaids
  highest-risk, highest-cost members.
• www.chcs.org