10/3/2014. Ohio Department of Medicaid
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1 Ohio Health Care Association Fall 2014 John McCarthy Medicaid Director Balancing Ohio: More Opportunities in the Community 2 1
2 Balancing Incentive Program (BIP) Background The Jobs Budget(2011) set out to reform and enhance long-term care across Ohio:» Creation of a Unified Long-Term Care System» Linked Nursing Facility payments to person-centered outcomes» Opened door to creation of an integrated care delivery model for Medicare-Medicaid beneficiaries» Renewed emphasis on Medicaid waivers and home and communitybased options Worked carried into SFY budget:» Ohio commits to the Balancing Incentive Program 3 Balancing Incentive Program (BIP) What is BIP? BIP is really about Front Door/Access points to the long-term care services and supports delivery system:» Too many people and loved ones do not know where to turn for non-institutional options» BIP is an opportunity to establish a faster track in linking individuals to opportunities in the community 4 2
3 Balancing Incentive Program (BIP) Finding Balance Goal: Direct 50% of all long-term care spending to home and community-based services (HCBS) by September 30, 2015» June 2013: Ohio receives $169 million in enhanced FMAP for BIP commitment» Conceptualization begins on a No Wrong Door /Single Entry Point system Assist people in applying for Medicaid and HCBS Harmony brought on to develop new system» September 2014: Ohio announces that it has reached BIP goal one year ahead of schedule(51.05% invested in HCBS) Milestone reached through a renewed commitment to waivers and home and community-based options 5 Balancing Incentive Program (BIP) Moving the Needle % 80.00% 60.00% 40.00% 20.00% How Ohio's HCBS LTSS balance has improved, per CMS data: 0.00% 32.50% 40% FFY 2009 FFY 2012 BIP approved for Ohio July 1, 2013:» December 2013: Ohio's HCBS LTSS balance = 42.7%» March 2014: Ohio s HCBS LTSS balance = 49.45%» August 2014: Ohio's HCBS LTSS balance = 51.05% and the work continues! 6 3
4 Another Medicaid Milestone HOME Choice Ohio s iteration of Money Follows the Person Original Goal: Transition 2,000 people out of institutional settings and back into home and community based options» : 968 transitions» Since 2011: More than 4,000 transitions» Summer 2014: Ohio Medicaid and its community partners successfully transition its 5,000 th individual back into the community 7 National Recognition HOME Choice In 2013: Ohio ranks secondamong all MFP states in overall institution-to-community transitions and firstfor transitioning the most individuals living with mental illness. 8 4
5 9 MyCareOhio: Medicaid Hot Spot Dual eligible individuals make up just 14% of the Medicaid population but consume 34% of total costs. 100% 14% Medicare 34% Medicaid Dual 80% Eligibles 60% 86% 66% 40% All Others 20% 0% Enrollment Spending 5
6 Why MyCare Ohio? MyCare Ohio: Overview» Approximately 182,000 dual-eligible residents of Ohio» Very little coordination between Medicare and Medicaid benefits» Fragmentation and waste too often the result» Integrate physical, behavioral and long-term care services into a seamless experience for the individual 11 Goals of Demonstration MyCare Ohio: Overview» Improve health outcomes» Identify new ways to reduce overall cost of care between systems» Provide individuals with a single point of contact for the administration of services» Establish a delivery system that is easy to navigate for both the individual and provider» Create a seamless transition between care settings and programs the needs of individuals change 12 6
7 MyCare Ohio: Enrollment Update» Enrollment began May 1 and phased in through June and July.» Multiple enrollment noticesmailed to residents in all seven regions prior to enrollment deadline.» Individuals will now have until the end of the year to decide which plan best fits their Medicare health care needs.» January 2015: Those who have not yet selected a Medicare plan will be enrolled in one of the MyCareOhio managed care plans to ensure the full coordination of their care. 13 Rate Modernization Home nursing and aide rate-setting» FY budget increased aggregate spending for Medicaid aide and nursing services by $20 million» Increase takes into account market data, education, licensure status, and length of time for service visits» Status: Ohio Medicaid is in process of meeting with stakeholders and associations to determine best next steps and implementation 14 7
8 Waiver Modernization» Continue to streamline waivers» Pay the same for the same service across all waivers» Remove barriers and other rules to reduce administrative burden 15 Payment Innovation: Ohio s Vision 16 8
9 Payment Innovation: Timeline The Governor s Office of Health Transformation (OHT) established with the goal to engage public and private partners to design and implement new health care delivery payment systems to reward value of services over volume. Sept. 2012: Ohio submits application for federal State Innovation Model (SIM) Design Grant. Feb. 2013: State awarded SIM design grant; begins work with McKinsey & Company and public/private partners on proposal design. July 2014: Ohio submits applications for federal SIM Test Grant (second phase) 17 Why medical homes and episodes? Medical homes provide the foundation for total cost/quality accountability Population-basedaccountability transcends delivery system Large long-term impact: prevention and chronic disease management Requires providers to fully transform business model away from FFS Requires significant provider capabilities and commitment Episodes nested within total cost of care for more specific accountability Patient-centereddesign around the patient journey thru delivery system Faster to impact: clear and specific opportunities for improvement Stages business model transition away from FFS for specialists/hospitals Faster to scale, independent of market structure or capabilities Fit with other models Both models being implemented agnostic of provider structure, can be carved out or carved in for ACO or capitation 18 9
10 Retrospective threshold model rewards providers for delivering cost-efficient, high-quality care 19 Five year plan to launch PCMHand episode model at scale Goal State s role 80-90% of Ohio s population in some value-based payment model (combination of episodes- and population-based payment) within 5 years Shift rapidly to PCMH& episode model in Medicaid FFS Require Medicaid MCO partners to participate / implement Incorporate into contracts of MCOs for state employee benefit program Year 1 Year 3 Year 5 Patient centered medical homes In 2014 focus on CPCi Payers agree to participate in design for elements where standardization and / or alignment is critical Multi-payer group begins enrollment strategy for one additional market Model rolled out to all major markets 50%of patients are enrolled Scale achieved state-wide 80%of patients are enrolled Episode-based payments State leads design of 5episodes perinatal, asthma (acute exacerbation), COPDexacerbation, PCI, and joint replacement Payers agree to participate in design process, launch reporting on at least 3 of 5 episodes in 2014 and tie to payment within year 20episodes defined and launched across payers 50+episodes defined and launched across payers 20 10
11 Questions 21 11
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