Thursday, June 2, 2011, 2-3:30 PM ET

Transcription

1 CHCS Webinar: ROI Forecasting Calculator for Health Homes and Medical Homes Thursday, June 2, 2011, 2-3:30 PM ET For audio, dial: (866) ; Meeting/Event Number: You may also listen to this event online via streaming audio. A video archive will be posted on following the event. This webinar is made possible through support from the Robert Wood Johnson Foundation.

2 CHCS Webinar: ROI Forecasting Calculator for Health Homes and Medical Homes Overview Allison Hamblin, Director, Complex Populations Center for Health Care Strategies

3 Today s Agenda Overview of ROI Forecasting Calculator Using the Calculator to Assess the ROI for your Health Home Program A Demonstration A User s Perspective Q&A 3

4 CHCS Mission To improve health care quality for low-income children and adults, people with chronic illnesses and disabilities, frail elders, and racially and ethnically diverse populations experiencing disparities in care. CHCS Priorities Enhancing access to coverage and services; Improving quality and reducing racial and ethnic disparities; Integrating care for people with complex and special needs; and Building Medicaid leadership and capacity. 4

5 Five Steps for Reducing Medicaid $$ LOW STEP 1: Reimbursement Across the board provider rate cuts Level of Difficulty STEP 2: Services STEP 3: Eligibility STEP 4: $-Driven Desperate Measures Eliminating optional services Cutting eligibility (harder to do because of MOE under ACA) TBD as states determine that cuts alone will not slow the rate of growth HIGH STEP 5: Quality/Value Accountable health care homes/systems Health and Medical Homes Value-based purchasing HIT adoption 5

6 Overview of the Calculator High-level planning and discussion tool for use by states and health plans, and other stakeholders: Make a financial case for obtaining resources for health home and medical home investments Analyze trade-offs associated with resource allocation alternatives Incorporate ROI considerations into overall program design Developed in partnership with the HSM Group Supported by the Robert Wood Johnson Foundation 6

7 History and Evolution : CHCS ROI Purchasing Institute Included 8 states: AZ, CO, CT, ID, LA, OK, PA, WA Supported by The Commonwealth Fund and RWJF Project goals: Test the utility of the ROI Forecasting Calculator for Quality Initiatives and improve it for public release Build state capacity to include ROI forecasting into planning of quality initiatives 2008: Public release : Growth of user base to : Translation for Health Homes/Medical Homes 7

8 CHCS Webinar: ROI Forecasting Calculator for Health Homes and Medical Homes ROI Calculator Demonstration Tricia McGinnis, Senior Program Officer Center for Health Care Strategies

9 The Health Homes Opportunity Medicaid will reimburse health homes for: (1) Comprehensive care management; (2) Care coordination and health promotion; (3) Comprehensive transitional care/follow-up; (4) Patient and family support; (5) Referral to community and social support services; and (6) Use of HIT to link services. To treat Medicaid beneficiaries with: Serious and persistent mental health condition; or Two or more chronic conditions (mental health, substance abuse, asthma, diabetes, heart disease, being overweight); or One chronic condition and at risk for a second. 9

10 Growing Evidence Base of Savings Program Focus % ED Visit Decrease Group Health Cooperative Puget Sound Community Care of North Carolina (Medicaid focus) % Hospitalization Decrease Savings PCMH (11 year 1) $10 PMPM PCMH (asthma) $400M ABD; $135M TANF Health Partners Group PCMH % reduction of state network average costs Geisinger PCMH N/A 14 $3.7 million/ 9%/$9 PMPM Genessee Health PCMH N/A South Carolina Blue Choice PCMH % medical and Rx cost BCBS North Dakota PCMH 24 6 $530 PMPY 10

11 Benefits of Using the ROI Calculator Estimate whether program investments will pay for themselves Assist with program planning efforts Is the right population targeted? What enrollment targets should be set? What program investments should be made? Are the utilization changes required for a positive ROI realistic? What PMPM rates will support a positive ROI? Account for the impact of unknowns 11

12 A Demonstration of the ROI Calculator 12

13 Resources Available from CHCS Online User s Guide ROI Databases on Program Impact and Program Costs Issue Brief: Using ROI Forecasting to Maximize the Value of Medicaid Investments Contact Tricia McGinnis at tmcginnis@chcs.org or

14 A User s Perspective Linda C. Stokes, MSPH, Cleveland Ohio Analyst for Care Management at MetroHealth Systems Practice Coach for Better Health Greater Cleveland 14

15 Questions? To submit a question please click the question mark icon located in the floating toolbar at the lower right side of your screen. Your questions will be viewable only to CHCS staff and the panelists. Answers to questions that cannot be addressed due to time constraints will be posted online after the webinar. A video archive of this event will be available on our website, at

16 Visit CHCS.org to Access the ROI Calculator Download practical resources to improve the quality and cost-effectiveness of Medicaid services. Subscribe to CHCS Updates to learn about new programs and resources. Learn about cutting-edge efforts to improve care for Medicaid s highest-need, highest-cost beneficiaries. 16