State Integrated Long Term Care Programs

1
State Integrated Long Term Care Programs

• September 7, 2006
• Mary Kennedy
• Vice President, State Public Affairs

2
Overview

• Evercare Care Coordination Model
• State Experiences with Integrated Long-Term Care
  Programs
• Arizona Long-Term Care System (ALTCS)
• Minnesota Senior and Disability Health Options
  Programs (MSHO MnDHO)
• Massachusetts Senior Care Options (MA SCO)

3
Care Management Model
evidence-based
4
(No Transcript)
5
Arizona Overview
6
ALTCS Key Features

• ALTCS generated very robust HCBS delivery system
• Full continuum of services from assisted
  living/group residential care to personal care
• Adequately funded personal care system, paid
  family caregivers
• Pass-thru for provider reimbursement rate
  increases
• State sets reimbursement levels for all
  providers, nursing homes to personal care
  providers
• FFS Medicaid rates included in ALTCS capitation
  payments and passed on to providers by plans
• Effectively operates statewide including very
  rural areas
• ALTCS includes both for-profit and
  county-sponsored plans

7
ALTCS Outcomes

• Community placement rate rose from 5 to 63 over
  17 years
• ALTCS 2001 Consumer Satisfaction Survey1
• 93 were satisfied overall with their care
  manager
• 95 were satisfied with their HCBS caregiver
• 90 were satisfied that the care manager involved
  the respondent in care decision-making
• In 1993, ALTCS saved 111.1 million compared to
  FFS Medicaid costs2

8
Minnesota Overview
9
MSHO Key Features

• Effective Medicare and Medicaid integration
• Coordination of HCBS with acute care services
• Improved management of chronic illness
• Success in the nursing home setting
• Reduced inpatient admissions for MSHO NH
  residents
• Improved monitoring of nursing home quality
  indicators
• Care coordination for well duals who do not
  require nursing home level of care

10
MnDHO Key Features

• Driven by consumer demand for a coordinated care
  model for people with physical disabilities
• Partnership between health plans and
  consumer-focused care management organization
• Active consumer board
• Relationships with key physicians experienced
  with physical disabilities
• 100 MnDHO enrollees transitioned from NHs to
  community

11
MSHO MnDHO Outcomes
MnDHO
MSHO

• Consumer Satisfaction4
• 90 of respondents reported higher overall
  satisfaction rates with their healthcare after
  enrolling in MnDHO
• Self-direction4
• 100 of survey respondents report being involved
  as much as they wanted in health care decision
  making after enrolling in MnDHO
• Almost half (45) felt that they were not
  adequately involved in making decisions until
  enrolling in MnDHO
• Reduced hospitalizations5
• Average inpatient length of stay was reduced by
  more than two-thirds for MnDHO enrollees when
  compared to prior utilization patterns

• Satisfaction Survey for family members of MSHO
  nursing home residents3
• 96 of families surveyed would recommend their
  MSHO health plan to others
• 94 of families surveyed would recommend the
  person coordinating care for their family member
  to others
• Reduced preventable hospitalization for MSHO
  enrollees4
• For community residents, the rate of preventable
  hospitalizations and ER use is lower for MSHO
  enrollees vs. control group
• MSHO nursing home enrollees had significantly
  fewer hospital admissions and ER visits compared
  to a control group

12
Massachusetts Overview
13
Mass SCO Key Features

• Very similar design to MSHO
• Also includes well duals
• Includes seniors only
• Partnership with AAAs
• Delays placement to nursing facilities
• Includes enhancements to Medicaid benefits
• Dental, podiatric, non-Part D pharmacy,
  transportation

14
Citations

• ALTCS 2001 Customer Satisfaction Survey,
  www.ahcccs.state.az.us/Publications/Reports/ALTCSu
  rveyProject/index.asp
• Nelda McCall, C. William Wrightson, Jodi Korb,
  Michael Crane, William Weissert, and John Milkin.
  Evaluation of Arizonas Health Care Cost
  Containment System Demonstration. February 1996.
  Laguna Research Associates, San Francisco,
  California.
• 2004 Consumer Assessment of Health Care MSHO
  Nursing Home Population. Minnesota Health Data
  Institute, August 2004
• Robert L. Kane, MD, et. al., Patterns of
  Utilization for the Minnesota Senior Health
  Options Program. Journal of the American
  Geriatrics Society, 2004
• Minnesota Disability Health Options (MnDHO)
  Longitudinal Survey MedStar Research Institute.
  NRH Center for Health Disability Research.
  http//www.dhs.state.mn.us/HealthCare/msho-mndho/r
  esearch/summary-preliminary-longitudinal-survey.pd
  f
• Minnesota Disability Health Options Expanding
  Coverage for Adults with Physical Disabilities,
  Susan Palsbo, PhD, Phillip Beatty, Pam Parker and
  Chris Duff, January 2004.

15
Contact Information

• Mary B. Kennedy
• Vice President, State Public Policy
• Evercare/Ovations
• MN008-W130
• 9900 Bren Road East
• Minnetonka, MN 55343
• 952-936-1382
• mary_b_kennedy_at_uhc.com