Innovating in an Era of Uncertainty

Transcription

1 Medicaid in New York State: Innovating in an Era of Uncertainty Cerebral Palsy Associations of NYS Annual Conference Jason A. Helgerson Medicaid Director October 30, 2017

2 Transforming Medicaid Services for New Yorker s with Developmental Disabilities 2

3 6.6 million people on Medicaid (1/3 of the State s population) 3 In NYS, 130,000 people use developmentally disabled services Annual budget of $68 billion-2 nd largest in the country Medicaid is the largest purchaser of healthcare services in the State

4 Overview 4 With stakeholders, NYS DOH and OPWDD are working to design programs that offer flexibility and choice, and achieve the best health and life outcomes for people The aim is to fully integrate today s extensive Home and Community Based Services (HCBS) with health and behavioral health services Step 1: Care Coordination Organizations/ Health Home (CCO/HH) to develop a single comprehensive Life Plan for each individual Step 2: Transition the I/DD system to managed care and a provider payment structure that focuses on improved outcomes for individuals served in our system.

5 Waiver Amendment DOH/OPWDD submitted an amendment to operate OPWDD services under the authority of the 1115 MRT Waiver, approval being sought concurrent with SPA amendment This amendment codifies plans for implementation of specialized managed care with an identified timeframe for Managed Care implementation: July 1, 2018 to July 1, Starting with voluntary enrollment Managed Care to operate initially as fee-for-service for OPWDD services, with capitation to be implemented after two years

6 MRT Waiver Trajectory Medicaid Service Changes Enrolling persons with I/DD in CCO/HHs Transitioning Targeted I/DD HCBS to 1115 Waiver OPWDD Provider-led Plans Voluntary enrollment in OPWDD provider led managed care plans Non-risk HCBS and residential services Dual eligibles (Medicaid and Medicare) with I/DD to enroll in specialized managed care for their OPWDD services Mainstream Medicaid Managed Care Mainstream plans to offer specialized OPWDD services as needed for Statewide coverage and choice same I/DD requirements Move to mandatory enrollment based on performance

7 Care Coordination Organizations/ Health Homes Care Coordination Organizations (CCOs) are based on the Health Home (HH) model, specialized for people with developmental disabilities to: Increase focus on outcomes & Improved cross-system care coordination Team approach to help people navigate multiple systems and transition points 7 Health Home refers to an interconnected team of health professionals working on behalf of the individual and providing six core services: Comprehensive Care Management Health Promotion Transitional Care Family and Caregivers Support Community and Social Support Services Health Information Technology

8 Care Coordination Organizations/ Health Homes 8 Establishes the framework, processes and culture that will govern our managed care model The benefits to a managed care model for individuals and families include expanded accessibility of services and supports, empowering community engagement and personal preferences, and paying more attention to prevention and wellness Care Coordination/Health Homes for I/DD is built on the existing Medicaid Service Coordination, but goes farther by incorporating the health, behavioral health, wellness and other services a person receives along with their OPWDDfunded supports in a single comprehensive plan Medicaid Service Coordinators are encouraged to become care managers

9 9 Care Coordination Organizations/ Health Homes Application: DOH and OPWDD released a joint Draft Application for public comment on June 30 and shared with CMS on September 1 Response to public comment outline changes made using stakeholder input The final application was released Friday October 6 th and Applications will be due November 30

10 10 CCO / HH Implementation Timeline June 2017 Draft Designation Application (Part 1)was published for public comment; comments were due 8/4/2017 Summer 2017 Submit revised State Plan Amendment to add I/DD diagnoses as a single qualifying diagnosis for Health Homes; Submit 1115 Medicaid Waiver Amendment October 6, 2017 Final Health Home Application (Parts 1&2) released along with Response to Public Comment document December 1, 2017 Designation Applications due to OPWDD / DOH, including proposed care management networks December 2017 February 2018 Review and approval of CCO / HH Applications by the State February 2018 to June 2018 CCO / HH readiness review activities July 1, 2018 First date for CCO / HH Care Management

11 Interaction With Value-Based Payments 11 Goal of 80-90% of payments made from MCOs to providers captured within VBP arrangements by 2020 The goal of VBP is to create a sustainable system and incentivize value over volume I/DD VBP Clinical Advisory Group (CAG) discussed implications of VBP for DD Will continue work with I/DD stakeholder community to determine meaningful measures and valued outcomes

12 Federal Uncertainty 12

13 13 The Future State of Healthcare

14 14 We Need to Challenge the Status Quo Health care has not fundamentally changed in 60 years We still go to health care once upon a time, healthcare came to us Technology can help us reimagine healthcare delivery Challenging the status quo is essential if we are to meet the needs of an aging population

15 15 Strategy 1 Think Cross System Social Services Education Health Care Criminal Justice Employment Housing

16 16 Strategy 2 Apply Design Thinking Design thinking is a problem-solving approach with a unique set of qualities: it is human centered, possibility driven, option focused and iterative. This approach is being applied in a variety of settings including healthcare. Healthcare is a great fit because we always say we want to put the patient in center when it comes to delivery. Thinking about how health care delivery is experienced by the patient. That will help us innovate and become more cost effective.

17 Strategy 3 Dare to Transform Not Simply Improve 17 Transformation is the most over used word in healthcare. Go beyond incremental and think big not a faster ship but an airplane. Let s make healthcare truly patient centered by making it easy to access. 1 Click Innovations use technology to improve quality and convenience

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