Planning a New Care Management Program NASHP PreConference Sponsored by AHRQ

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Planning a New Care Management Program NASHP
Pre-Conference Sponsored by AHRQ

• Cheryl J. Roberts, J.D.
• Deputy of Programs and Operations
• Department of Medical Assistance Services
• Commonwealth of Virginia
• Sunday, October 2, 2008

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Presentation Overview

• Virginia Program Overview
• Weddings and Care Management?
• Wedding and Care Management Planning Tips
• Closing and Questions

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Virginia Medicaid

• Currently cover 700,000 recipients.
• Expend about 6 Billion per year.
• 55 of participants are in a Managed Care
  Organization including the ABD population.
• 70 of funding goes toward long-term care and
  services for individuals with disabilities.
• LTC is community focused HCBS waivers, 7 PACE
  sites, Money Follows the Person, and VALTC pilot
  (the integration of LTC and managed care).
• Virginia has operated a disease management (DSM)
  program since 2006.
• Implementing a chronic care coordination program
  in 2008.

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Disease Management (2006)

• Program operational since 2006 under DRA
  provision.
• Voluntary enrollment, telephonic program.
• No of enrollees high intensity 2,000 low
  intensity 3700.
• Five disease states CAD, CHFD, COPD, asthma, and
  diabetes.
• Developed as a quality initiative and uses
  HEDIS-like measures.
• Health Management Corporation handles DSM
  contract for DMAS FFS, state employees, and
  largest Medicaid contracted MCO.
• All VA Medicaid MCOs must
• have DSM programs for same 5
• conditions.

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Chronic Care Management(projected implementation
date 1/2009)

• More holistic program for FFS recipients who have
  high dollar claims and unmanaged care.
• Will use predictive modeling tool, assessments
  and telephonic and face-to-face case management
  services.
• Voluntary enrollment in two tiers high and low.
• Excludes the 5 DSM conditions.
• Developed as a quality and cost savings measure.
• Developed SPA under DRA provision.
• RFP released July 2008, responses due at the end
  of September 2008.

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Planning a Wedding and Developing a Care
Management Program

• What could they have in common?

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A Lot!
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Planning Tips for Weddings and Care Management
Programs
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Wedding Tip No. 1 The Groundwork

• A good wedding starts with a great plan and a
  great man.
• By sticking with the plan, hopefully you will
  end up with the great plan and man!
• Vision
• Project planning
• Implementation

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Care Management Tip No. 1 The
Groundwork

• Vision
• Select the type of program you want look at
  other state models, private sector, industry
  trends, your own state structure and
  infrastructure. Document plans and concepts as a
  blue print.
• Planning
• Determine what federal and state approval and
  budgetary support you will need and how to obtain
  it.
• Find a someone to lead and champion program.
• Join entities like ARHQ to assist you in network
  and program development.
• Implementation
• Develop a project plan.
• Place contingencies in the plan.
• Keep track of major items.
• Get support for interfaces, research, and data
  analysis
• Ensure implementation stays in line with vision.

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Wedding Tip No. 2
Communications Strategy

• There is no need to send out formal invitations
  anymore.
• Use Evites, texts, You Tube, web sites and
  Facebook.
• For the few people over age 90 for whom you have
  to use snail mail download invitations from the
  web and generate them on your computer.

No one RSVPs anyway!
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Care Management Tip No. 2 Communication
Strategy

• Develop a strong communication strategy with
  external parties. Make sure your message is
  simple, clear, and easy to understand.
• Program must sound, logical, and doable.
• Make communications relevant to the audience and
  use different mediums.
• Clients may need several different venues DVDs,
  letters, web, video, interactive materials.
• For external groups, create materials that
  explain 1) How the program will operate and 2)
  How it will affect them. Always include WIIFM in
  the commutation (Whats in it for me?).
• Allow interested parties opportunities to respond
  and provide input.
• Provide annual reports and updates.

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Wedding Tip No. 3 Invite both of your ENTIRE
families

• Use this opportunity to invite the entire
  family immediate, close, extended, distant, and
  complicated connections.
• The pictures will be more valuable.
• Excluding family members will hurt you more in
  the long run than the pain caused by a few hours
  of tolerance.

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Care Management Tip No. 3 Invite all
stakeholders to the table

• Federal and State Authority Get buy in from CMS
  and state budget/regulatory authority from the
  beginning.
• You need an authority GPS
• Advocates and Providers - Get their buy in
  consider the affect on established care patterns.
  Spend time to educate and orientate them on your
  vision and plan. Place them in advisory
  partnerships.
• Vendors Use the opportunity to
• talk to vendors. Invite them to
• visit hear what they have to
• offer. Ensure they are
• inclusionary and flexible.

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Wedding Tip No. 4 Is a real cake absolutely
necessary?

• A real cake or fake one?
• You only need a wedding cake for the pictures.
• So, create one out of Styrofoam and decorate it
  with icing and flowers for the pictures. Then
  serve your guests a grocery store sheet cake.
• Extra savings Find a birthday cake that
  someone did not pick up.

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Care Management Tip No. 4 Dont create a
program just for show.

• Your program needs to be more than show.
• It must have definitive outcomes.
• Health outcomes Be able to document that
  enrollees are better off for participating in the
  program managed care, change of treatment plans,
  change in venue, higher scores, medication
  management adherence. More than just reporting
  happy/satisfaction.
• Cot avings - After determining a reasonable
  savings expectation, develop a mechanism in which
  this will be achieved and reported. You will need
  to isolate program intervention to determine
  savings.
• Managed care managed savings expectations
  success

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Focus on Quality Diabetes Management

• www.dmas.virginia.gov/dsm.htm

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Wedding Tip No. 5 Be flexible and open to new
ideas

• Best cost saver
• Have wedding and reception at sunrise.
• You get same orange sun as you do at sunset PLUS
  much better symbolism.
• You can invite everyone without fear of going
  over budget. A breakfast reception is much
  cheaper.

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Care Management Tip No. 5 Build in
flexibility and be open to new ideas

• Project will evolve and need the flexibility to
  change
• New priorities new trends and ideas and
• New internal and external pressures.
• Build in contract flexibility
• Growth and shrinkage in program
• Ability to stop certain pieces and continue with
  others and operate some pieces internally.
• Continue to research and learn
• Do not believe you have the golden goose- new
  ideas are born everyday.
• Compromise is not a bad word
• Keep focused on the goal and plan as you make
  decisions.

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Wedding Tip No. 6 Times are tight, but
dont skimp on everything!

• Dont skimp on everything.especially not on the
  photographer!
• When its all said and done, all you will have
  are pictures, memories, and credit card bills as
  a remembrance of the day.

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Care Management Tip No. 6 Times are tight,
but dont skimp on everything!

• Dont skimp on evaluation process!
• After a year of operation everyone will want
• to know the programs ROI.
• Decide on the evaluation and reporting processes
  before you implement.
• CHCS has a tool and a program for quality and ROI
  and there are a series of research models (e.g.,
  control groups).
• Look at HEDIS, URAC and QIO for ideas.
• Find an independent source to evaluate program.
• The vendors annual report is not enough.
• Think about using State Universities, EQRO, etc.
  
• Ensure that the evaluation terms are in the
  contract.

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Focus on Outcomes What gets measured gets
done

• Asthma HEDIS Outcomes
• 2004 2005 2006
• Admits / 1000 50.0 52.7 42.3
• ED visits / 1000 269.8 265.1 250.5
• Appropriate Meds
• Ages 5-56 67.7 86.9 88.3
• Actions
• Outreach partnership with community organization.
• Automatic telephone call reminder system.
• Asthma COPD provider guideline tools.

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Wedding Tip No. 7 Beware of too good to
be true

• Watch out for bargains that seem too good.
• Before you buy the honeymooners that 99.00
  Caribbean cruise you saw on eBay- check for
  references.

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Care Management Tip No. 7 Dont just
select the lowest bidder

• Care management has become a multi-million dollar
  business.
• And with the gold rush there are many vendors,
  purchasing ideas, and helpful friends.
• There are no bargains what appears to be too
  good to be true is.
• Choose a vendor carefully.
• Always include a prenuptial language not just
  sanctions but a way out if both parties do not
  agree.
• These program are not going to save the budget
  but they should control trends.
• The biggest unknown is that you cannot control
  recipient behavior or participation you just
  hope to influence it.

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Happily Ever After

• Like a wedding, care management programs entail a
  lot of work and expense
• Vision
• Planning
• Implementation
• All focused on achieving two outcomes improving
  health outcomes and producing cost savings.
• Is it all worth it???

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Yes
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The End.

• Thank you!