Investing in Health Care That Works for All Californians. Melissa Buckley September 27, 2016

Transcription

1 Investing in Health Care That Wrks fr All Califrnians Melissa Buckley September 27, 2016

2 Venturing int New Territry Health care delivery system + technlgy + investments + fundatin grantmaking + Medicaid... Tp Things t Knw Abut Medicaid and the Safety Net Delivery System

3 The medicaid market is large and grwing Health Insurance Cverage by Type (2015) Medicaid Enrllment (millins) % 18% % 23% grwth 52% Medicaid Medicare Emplyer based Direct purchase Surce: US Census, Health Insurance Cverage in the United States: 2015

4 Variability is the rule and dynamics are lcal Medicaid Spending Per FYE Full-Benefit Enrllee, FY 2012 Highest spending states Lwest spending states DC Alaska Nrth Dakta Massachusetts Rhde Island New Yrk Minnesta Cnnecticut Pennsylvania New Jersey Mntana Ttal Texas Califrnia Tennessee Hawaii Alabama Suth Carlina Arizna Nevada Flrida Illinis Surce: Medi-Cal Landscape Assessment, Manatt Health, June 2016 * MACStats: Mediciad and CHIP Data Bk, December 2015 $7,482 $6,307 $6,141 $6,056 $5,925 $5,679 $5,630 $5,597 $5,595 $5,453 $5,008 $13,003 $12,086 $11,834 $11,752 $10,978 $10,393 $10,298 $9,838 $9,672 $9,590 $9,318 *$498 billin ttal in 2014

5 Mst payments are value-based Enrllment in Medicaid Managed Care vs. FFS (2014) Fee Fr Service 23% Managed Care 77% Surce: Medicaid Managed Care: An ACAP Analysis, Assciatin fr Cmmunity Affiliated Plans

6 Finding the true custmer can take wrk Delegatin: Wh hlds the risk? State Primary Managed Care Plan Carve Outs: Wh is respnsible fr services? Specialty mental health Health Plan X Health Plan Y Alchl/substance use disrder treatment IPA 2 IPA 1 Lng-term care Hspital A Individual Prviders In-hme Supprtive Services Nn-medical Dental Surce: Medi-Cal Landscape Assessment, Manatt Health, June 2016

7 Mre care is delivered in cmmunity clinics Surce: Califrnia s Health Care Safety Net: A sectr in Transitin, January 2016, Califrnia Health Care Fundatin

8 Managed care plans cmpensate fr lw FFS rates thrugh targeted enhanced reimbursements Physician Reimbursement Rates, Medi-Cal vs. Medicare Selected High Frequency Services, 2014 Surce: Califrnia s Health Care Safety Net: A sectr in Transitin, January 2016, Califrnia Health Care Fundatin

9 Access t prviders is challenging Physicians Accepting New Patients by Cverage Type, 2013 Medi-Cal Medicare 87% 86% 81% 63% 62% 52% 36% 45% SURGERY MEDICAL SPECIALTIES GENERAL INTERNAL MEDICINE PSYCHIATRY Surce: Physician Participatin in Medi-Cal: Ready fr the Enrllment Bm?, August 2014, Califrnia Health Care Fundatin

10 Greater prevalence f chrnic cnditins and pr mental health Selected characteristics f adults <139% FPL Uninsured Medicaid Emplyer >1 Chrnic Cnditin 19% 32% 38% Fair/Pr Mental Health 7% 12% 26% Fair/Pr Health 11% 18% 36% Surce: What Difference Des Medicaid Make: Assessing Cst Effectiveness, Access, and Financial Prtectin under Medicaid fr Lw-Incme Adults, May 2013, Kaiser Cmmissin n Medicaid and the Uninsured.

11 Cumulative percent f Ttal Spending Csts are cncentrated at the tp 100 Medi-Cal Spending Distributin Department f Health Care Services Analysis 100% Tp 1% generated 27% f spending Tp 5% generated 52% f spending 48% 73% % % 0 Percent f Ppulatin by Share f Ttal Expenditures Surce: Understanding Medi-Cal s High-Cst Ppulatins, March 2015, Califrnia Department f Health Care Services

12 Opprtunities lk different Ppulatin health Integrated behaviral health Crdinated care management Data analytics w/ scial determinants Ability t manage risk Leveraged wrkfrce and remte access Telehealth One-t-many prvider-patient platfrms Tp f license practicing Scalable mdels

13 CHCF is a partner in Medicaid navigatin We wrk t ensure that peple have access t the care they need, when they need it, at a price they can affrd, by: Investing in new and emerging technlgies in the safety net Evaluating impact Amplifying what wrks