Medicaid Redesign Team Update and Next Steps

Transcription

1 Redesign Medicaid in New Yrk State Medicaid Redesign Team Update and Next Steps Significant Prgress, Lts Still t Be Dne July 10, 2013 United Hspital Fund Jasn A. Helgersn, Medicaid Directr NYS Department f Health

2 Agenda 1) MRT Implementatin t Date Lwering Csts Imprving Quality 2) Lking Ahead t 2014 Majr Implementatins 3) Majr Outstanding Plicy Questins 4) Q & A Redesigning Medicaid in New Yrk State 2

3 MRT Implementatin t Date Are We Lwering Csts and Imprving Outcmes?

4 The MRT is Bending the Cst Curve Lwered ttal Medicaid spending by $4 billin in Year 1. Lived within the Glbal Spending Cap fr tw full years. Finished Year Tw $200 millin under the Glbal Spending Cap. Thanks t the MRT the state was able t absrb a $1.1 billin federal revenue lss due t a change in Medicaid financing fr DD services. Savings has been especially significant in New Yrk City. Redesigning Medicaid in New Yrk State 4

5 Aggregate Spending fr all Prgrams (in Billins) NY Ttal Medicaid Spending Statewide fr All Categries f Service Under the Glbal Spending Cap ( ) $48 $46 $44 $42 $40 $38 $36 $34 $ MRT Actins Implemented $4.6 billin Estimated Savings Prjected Spending Absent MRT Initiatives * $ Year # f Recipients Cst per Recipient 4,266,535 4,593,566 4,732,563 4,729,166 4,621,909 4,656,354 4,910,511 5,211,511 5,396,521 5,578,143 $7,635 $7,658 $7,787 $7,710 $8,158 $8,464 $8,493 $8,379 $8,261 $7,864 *Prjected Spending Absent MRT Initiatives was derived by using the average annual grwth rate between 2003 and 2010 f 4.28%.

6 Aggregate Spending fr all Prgrams (in Billins) # f Recipients Cst per Recipient NYC Ttal Medicaid Spending fr All Categries f Service Under the Glbal Spending Cap ( ) $29 $28 $27 $26 $25 $24 $23 $22 $21 $20 Years 2011 MRT Actins Implemented ,815,890 3,014,656 3,114,104 3,145,267 3,077,097 3,072,893 3,197,304 3,351,189 3,427,870 3,487,966 $7,397 $7,406 $7,477 $7,406 $7,807 $8,121 $8,272 $8,251 $8,183 $7,810 * Prjected Spending Absent MRT Initiatives was derived by using the average annual grwth rate between 2003 and 2010 f 4.1%. Prjected Spending Absent MRT Initiatives * $3.2 billin Estimated Savings

7 $10.0 $9.5 NYC Medicaid Lng Term Care Spending ( ) Prjected Spending Absent MRT Initiatives * Aggregate Spending fr all Prgrams (in Billins) $9.0 $8.5 $8.0 $7.5 $ MRT Actins Implemented $980 millin Estimated Savings $6.5 $ Years # f Recipients 181, , , , , , , , , ,062 Cst per Recipient $34,438 $36,726 $38,933 $40,732 $42,700 $43,841 $43,867 $43,977 $43,363 $42,629 * Prjected Spending Absent MRT Initiatives was derived by using the average annual grwth rate between 2003 and 2010 f 4.4%.

8 MRT is Imprving Patient Outcmes

9 NYS Managed Care Plans #2 in the Natin Example #1 Natinal Cmmittee fr Quality Assurance (NCQA) analyzed New Yrk s Medicaid health care plans against 76 different quality measures. NYS plans are especially successful when it cmes t ffering the right type f care fr cmmn, cstly diseases, fr example: Diabetes; Childhd besity; Smking cessatin; Fllw-up care fr the mentally ill. NCQA fund that New Yrk is a natinal leader, secnd nly t Massachusetts. Surce: NCQA: Redesigning Medicaid in New Yrk State 9

10 Managed Lng Term Care Imprving Patient Outcmes Example #2 MRT 90, Mandatry Enrllment in MLTC Plans: Expands MLTC fr Medicaid members wh are als eligible fr Medicare (dual eligibles) and currently receiving cmmunity-based lng term care services. Benefit package includes hme care, persnal care, scial supprts, and transprtatin services. The csts f skilled nursing facility services are included in the capitatin payment, prviding a financial incentive fr the plans t keep their members healthy and living in the cmmunity. MLTC enrllment has steadily increased ver the past cuple years: Enrllment has increased frm apprximately 10,000 in 2004 t nearly mre than 100,00 as f May 2013; Number f plans has grwn frm 16 plans t mre than 40 plans. Redesigning Medicaid in New Yrk State 10

11 Managed Lng Term Care Imprving Patient Outcmes (cntinued) Example #2 MLTC is imprving utcmes and the feedback is favrable. The New Yrk State Department f Health 2012 Managed Lng Term Care (MLTC) Reprt fund that: the verall functinal ability f 90 percent f MLTC enrllees has remained stable r imprved; 85 percent f MLTC plan members rated their health plan as gd r excellent ; 91 percent wuld recmmend their plan t a friend, and Less than 2 percent f members are in nursing hmes. Redesigning Medicaid in New Yrk State 11

12 Health Hmes Are Reducing Inpatient Utilizatin & ER Use Health Hmes are in their early days. Example #3 Patients with little r n histric cnnectin t traditinal health care are benefiting the mst. Preliminary results are fr Phase 1 and Phase 2 cunties. Redesigning Medicaid in New Yrk State 12

13 Inpatient Service Cst fr a Subset f Health Hme Enrlled Members Example #3 * Includes individuals cntinuusly enrlled in Medicaid with n case management services in calendar 2011 wh enrlled in Health Hme Services in the first six mnths f N = 194 individuals. Redesigning Medicaid in New Yrk State 13

14 ER Service Cst fr a Subset f Health Hme Enrlled Members Example #3 * Includes individuals cntinuusly enrlled in Medicaid with n case management services in calendar 2011 wh enrlled in Health Hme Services in the first six mnths f N = 194 individuals. Redesigning Medicaid in New Yrk State 14

15 Lking Ahead t 2014: Majr Implementatins

16 Significant Implementatins 1) Affrdable Care Act 2) MRT Waiver Amendment 3) FIDA Demnstratin 4) Behaviral Health Carve-in/HARP Redesigning Medicaid in New Yrk State 16

17 Affrdable Care Act (ACA)

18 ACA Implementatin & Medicaid Administratin Refrm The Affrdable Care Act (ACA) is a tremendus pprtunity fr New Yrk State: 1 millin New Yrkers will gain access t health insurance; Additinal federal financing fr Medicaid will help ensure prgram sustainability; Building a new health insurance exchange will allw the state t phase-ut the ut-f-date WMS eligibility system. New Yrk will perate its wn exchange and will use the launch f the exchange t als facilitate the state takever f Medicaid administratin frm cunties. Redesign Medicaid in New Yrk State 18

19 ACA Implementatin & Medicaid Administratin Refrm State take-ver will prvide cunties with mandate relief and create greater cnsistency in custmer treatment acrss the state. Full state takever will take five years t implement. Standing up the exchange by Octber 1, 2013 is a majr challenge fr DOH and ur partners. Lts f wrk ahead! Redesign Medicaid in New Yrk State 19

20 MRT Waiver Amendment

21 MRT Waiver Amendment We currently have a waiver amendment pending with CMS that wuld allw us t reinvest $10 billin in MRT generated federal savings back int New Yrk s health care delivery system. The amendment is essential t bth fully implement the MRT actin plan as well as prepare fr ACA implementatin. The amendment, which requires federal apprval, is a unique pprtunity t address the underlying challenges facing NYS health care delivery: Lack f primary care; Weak health care safety net; Health disparities; and Transitin challenges t managed care. Redesign Medicaid in New Yrk State 21

22 MRT Waiver Reinvestment Strategies Primary Care Expansin ($1.25 billin ver the next five years). Health Hme Develpment ($525 millin ver the next five years). New Care Mdels ($375 millin ver the next five years). Expand Vital Access/Safety Net Prgram ($1.5 billin ver the next five years). Public Hspital Innvatin ($1.5 billin ver the next five years). Medicaid Supprtive Husing ($750 millin ver the next five years). Lng Term Transfrmatin - Integratin t Managed Care ($839.1 millin ver the next five years). Redesign Medicaid in New Yrk State 22 22

23 MRT Waiver Reinvestment Strategies Capital Stabilizatin fr Safety Net Hspitals ($1.7 billin ver the next five years). Hspital Transitin ($520 millin ver the next five years). Ensuring the Health Wrkfrce Meets the Needs in the New Era f Health Care Refrm ($500 millin ver the next five years). Public Health Innvatin ($395.3 millin ver the next five years). Reginal Health Planning ($25 millin n average annually ver the next five years). MRT and Waiver Evaluatin Prgram ($500 millin ver the next five years). Redesign Medicaid in New Yrk State 23

24 FIDA Demnstratin

25 FIDA Demnstratin A key step in the mve t care management fr all is the prpsed Fully Integrated Dual Advantage (FIDA) demnstratin prject. Thrugh this effrt 170,000 dually eligible members (Medicaid and Medicare) will be enrlled int full-integrated managed care prducts. The enrllment prcess will rely n a cnversin in place apprach under which duals enrlled in MLTCP plans will see their Medicare benefit added t their managed care plan s prtfli. Members will be able t p-ut f the Medicare managed care prduct. Redesign Medicaid in New Yrk State 25

26 FIDA Demnstratin Tw Types f Plans: Primary FIDA Dual eligibles, age 21 and ver that require cmmunity-based lng term care services fr mre than 120 days wh are nt residents f an OMH facility, and wh are nt receiving services frm the OPWDD system. Gegraphic Service Area: Brnx, Kings, New Yrk, Queens, Richmnd, Nassau, Sufflk and Westchester Cunties OPWDD FIDA Dual eligibles, age 21 and ver, wh are nt residents f an OMH facility, and wh are receiving services frm the OPWDD system Gegraphic Service Area: Statewide Redesign Medicaid in New Yrk State 26

27 FIDA Demnstratin Prpsed Enrllment Prcess: In April 2014, begin accepting vluntary enrllments fr individuals in need f cmmunity-based lng-term care services greater than 120 days. In July 2014, begin prcess f passive enrllment ntificatin fr individuals in need f cmmunity-based lng-term care services greater than 120 days. In Octber 2014, begin accepting vluntary enrllment fr dual eligible individuals that have exhausted Medicare benefit in nursing hmes. Redesign Medicaid in New Yrk State 27

28 FIDA Demnstratin In January 2015, begin prcess f passive enrllment ntificatin fr dual eligible individuals that have exhausted Medicare benefit in nursing hmes. This will be applicable t eligible individuals in the FIDA demnstratin area. Eligible individuals can pt-ut f passive enrllment. Enrllment brker will prvide enrllment cunseling and assistance. Redesign Medicaid in New Yrk State 28

29 FIDA Demnstratin Prpsed Cvered Benefits: NYSDOH is prpsing t use the NY Medicaid definitin f medical necessity fr all services. Cvered Services include services cvered by the existing Medicare and Medicaid prgrams in New Yrk in additin t Hme and Cmmunity-Based waiver services. FIDA plans will have discretin t supplement cvered services with nn-cvered services r items where s ding wuld address a Participant s needs, as specified in the Participant s Persn-Centered Service Plan. Redesign Medicaid in New Yrk State 29

30 FIDA Demnstratin Status Update: The FIDA prpsal has nt yet been apprved by CMS. NYSDOH is wrking with CMS n implementatin funding fr the first tw years. NYSDOH is cncurrently wrking with CMS n a Memrandum f Understanding (MOU) and anticipates that it will be cmpleted in July Redesign Medicaid in New Yrk State 30

31 Behaviral Health Carve-In/ HARP

32 Behaviral Health Carve-In/ HARP Key MRT bjective is t mre effectively integrate physical and behaviral health services. Scpe f prject is brad with cllabratin between and amng DOH, OMH, OASAS, OCFS, NYC, stakehlders and lcal gvernmental units. Apprximately 695,000 members impacted. $7B in Spend mved int Managed Care. Transitin f BH Services will include BH State Plan Services, and specialized cmmunity-based services including Peer Supprt, Respite, Crisis and Emplyment. Redesign Medicaid in New Yrk State 32

33 Behaviral Health Carve-In/ HARP MRT guiding principles f the BH Design include: Persn-Centered Care Management thrugh Health Hmes where eligible. Patient/Cnsumer Chice. Savings frm unnecessary inpatient services will be reinvested int BH ambulatry and ther cmmunity-based services Tracking f BH and Physical Health (PH) spending, and reinvestment f savings frm unnecessary inpatient care int BH ambulatry and ther cmmunity-based services. Address Unique needs f Children and Families. Center f Excellence Guidelines. Redesign Medicaid in New Yrk State 33

34 New Yrk s Design fr Managed Behaviral Health fr Adults (21 and lder) Behaviral Health will be managed by: Special Needs Health and Recvery Plans (HARPs) fr individuals with significant behaviral needs. Mainstream Managed Care Plans. Plans may perate services directly nly if they meet rigrus standards. Plans that d nt meet rigrus standards must partner with a BHO which meets standards. Children s design is still under develpment. Redesign Medicaid in New Yrk State 34

35 MRT BHO/HARP Timeline MRT Milestne Adult (NYC) Adult (Rest f State) Kids Finalize prgram design Spring 2013 Spring 2013 Finalize BHO/HARP/MCO managed care cntract requirements Summer 2013 Summer 2013 Pst prcurement n website Late Summer 2013 Winter 2014 fr at least 30 days Select HARPs and Qualify Plans/BHOs fr mainstream benefits Winter 2013 Summer 2014 Plans fully peratinal Spring 2014 Fall 2014 Spring 2015 Redesign Medicaid in New Yrk State 35

36 Majr Outstanding Plicy Questins

37 Questin #1: Hw will the state share MRT savings with prviders? MRT is beginning t really bend the cst curve. T many prviders Medicaid payments = Vital revenue. MRT created sme mechanisms fr sharing savings but as savings grw new, mre systematic methds will be necessary. Redesign Medicaid in New Yrk State 37

38 Optin #1: Glbal Shared Savings State captures shared savings by lwering managed care payments as csts decline. State then devises mechanisms t make either direct payments t prviders r t require payments thrugh managed care plans. Payments culd be linked t bth perfrmance measures and t ensuring financial survival fr vital access prviders. Redesign Medicaid in New Yrk State 38

39 Optin #2: Managed Care Shared Savings Require managed care rganizatins t develp plans fr shared savings with their prvider netwrks. The state wuld apprve all plan shared savings agreements and ensure thse agreements are enfrced. Plans wuld be free t use back end shared savings agreements, sub-capitatin and perfrmance bnus payments as vehicles fr sharing savings with prviders. Mdel may be tested in the FIDA demnstratin. Redesign Medicaid in New Yrk State 39

40 Questin #2: Hw shuld Medicaid partner with the Exchange in health care purchasing? ACA implementatin is a great pprtunity t align incentives in public health care purchasing. Once the Exchange is live and stable DOH will lk fr ways t align payment plicies s as t encurage better alignment f incentives in the delivery system. While this is a great pprtunity the state will need t mve frward carefully especially during the early years f the Exchange. In additin t the Exchange the state will need t lk at additinal partnerships with ther payers acrss the state t see what kinds f multi-payer refrm effrts are pssible. Redesign Medicaid in New Yrk State 40

41 Questin #3: Hw can Medicaid leverage advances in HIT t imprve utcmes and lwer csts? Universal adptin f electrnic health recrds and the All Payers Claims Database create an pprtunity fr Medicaid t mve perfrmance measurement beynd the traditinal HEDIS measures. If the state can cllect ppulatin-wide health and public health utcme measures we have an pprtunity t really fcus plans n imprving the verall health f the Medicaid ppulatin. This evlutin will be especially imprtant as mre ppulatins are added t Medicaid managed care ver the next several years. Redesign Medicaid in New Yrk State 41

42 Questins?

43 Cntact Infrmatin We want t hear frm yu! MRT website: mrtwaiver@health.state.ny.us Subscribe t ur listserv: Like the MRT n Facebk: Fllw the MRT n Redesign Medicaid in New Yrk State 43