AREA AGENCIES ON AGING ASSOCIATION OF MICHIGAN Integrating care for People on Medicare and Medicaid May 17, 2012

Transcription

1 AREA AGENCIES ON AGING ASSOCIATION OF MICHIGAN Integrating care for People on Medicare and Medicaid May 17, 2012 Rick Murdock Executive Director Michigan Association of Health Plans 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 1

2 Integrating Care for People on Medicare and Medicaid Presentation Outline Background on MAHP Consensus Building and MAHP Engagement Challenge Based on Data Lessons from Past Areas of Agreement Concerns/Recommendations 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 2

3 MAHP: Who We Are MAHP Mission is to provide leadership for the promotion and advocacy of high quality, affordable, accessible health care for the citizens of Michigan. MAHP represents 16 health plans covering all of Michigan and 45 related business and affiliated organizations MAHP Member Health Plans provide coverage for nearly 2.8 million Michigan citizens nearly one in every three citizens in Michigan MAHP Health Plans employ about 8,000 persons all of whom pay taxes in Michigan. MAHP members collect and use health care data, supports the use of evidence based Medicine and facilitate disease management and care coordination in order to provide cost-effective care. 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 3

4 MAHP: Who We Are MAHP Member Health Plans: - CareSource Michigan2,3 -Grand Valley Health Plan 1 - Health Alliance Plan 1,3 -Meridian Health Plan2,3 - HealthPlus of Michigan 1,2,3 -McLaren Health Plan1,2 - Midwest Health Plan2,3 -Molina Healthcare of Michigan2,3 - Omnicare Health Plan2 -Paramount Care of Michigan 1 - Physicians Health Plan of Mid-Mich 1,2 -Priority Health 1,2,3 - ProCare Health Plan 2 -Total Health Care 1,2 - United Health Plan/Great Lakes 1,2,3 -Upper Peninsula Health Plan 2,3 - Key : 1 = Commercial Health Plan 2= Medicaid Health Plan 3= Medicare Advantage or Medicare Special Needs Plan 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 4

5 Coverage for Michigan Citizens (Millions) Large Group- Insured Large Group- ERISA Medicaid Medicare Uninsured Small Group Individual Market 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 5

6 MAHP Engagement on the MDCH Initiative for Integrative Care for Persons with Dual Eligibility Grant Application Process (Feb-April 2011): Active Encouragement and Support for Grant Initiative Consistent with MAHP Strategic Plan Active Behind Scene support with CMS Innovations Office to support MDCH Grant Application Grant Implementation Initial Awareness (May-July 20ll) Informal and Formal Interviews and discussions with PSC Highlight at 2011 MAHP Summer Conference (General Session and Workshops with CMS and MDCH) Initial MDCH Summer Forums communication to members 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 6

7 MAHP Engagement on the MDCH Initiative for Integrative Care for Persons with Dual Eligibility Formal Stakeholder Process Workgroups (July Jan 2012) MAHP members on each MDCH workgroup Consultants provide MDCH and PSC staff with background materials on value of managed care Additional Input (July 2011 March 2012) RFI Response on managed care approaches Joint Consensus Statement with other Trade Groups followed by dinner meeting with Director Dazzo Joint meetings with other trade groups on partnerships Briefings with Legislators on Budget Issues and Duals Release of MDCH Plan and Subsequent Internal MAHP meetings and formal Board meeting (March 16 th ) Testimony at Senate Hearings (March 22 nd ) 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 7

8 MAHP Engagement on the MDCH Initiative for Integrative Care for Persons with Dual Eligibility Strategic Plan Submission and CMS Review (April 2012)_ Part of Joint Communication on Process and First Steps to Support MDCH Submission MAHP Board of Directors Meeting Review (May 15, 2012) MAHP Comments to CMS (Pending) 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 8

9 Consensus Building Beginning in July 2011, a collaboration was formed, a consensus resolution developed, and guiding principles adopted by the following endorsing organizations and provided to MDCH: Area Agencies on Aging Association of Michigan Aging Services of Michigan Health Care Association of Michigan Michigan Association of Community Mental Health Services Boards Michigan Association of Health Plans Subsequently endorsed by Michigan County Medical Care Facilities Association and Communication shared with Michigan Primary Care Association and Michigan Health and Hospital Association 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 9

10 Principle # Consensus Principle 1 Core elements should be as outlined in the MDCH initial grant proposal. 2 Build on strengths of Michigan s current Medicaid managed care system. 3 Person centered planning and self direction at core of continuum of care. 4 Non-traditional services/supports must be part of essential benefit package. 5 Care Coordination & Management is structured by needs of the population. 6 Integration of Care is at the direct service delivery level, and Integration of Administration to include expertise in physical, BH, LTC. 7 Choice & Eligibility should embrace consumer choice and implement eligibility changes consistent with Accountable Care Act. 8 Performance Measures & Incentives be clear, transparent, aligned and timely. 9 Phase In systems of integrated care based on evidence of preparedness. 10 Managed Care Considerations should be based on strengths of current system. 11 Technology incorporated to assure rapid, secure, confidential data sharing. 12 State Safety Net infrastructure will be preserved and supported.

11 New Partnerships Area Agencies on Aging Association and MAHP interactions and Health Care Association of Michigan: Board Meeting Presentations on Reform Joint Meetings of members to share awareness and expertise Commitment to continue On going meetings of Trade Association Executives on Reform and to Achieve a Common Agenda and next steps beyond Consensus Principles. 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 11

12 Michigan DEs Chronic Conditions Condition # of Individuals % of Duals Ischemic Heart Disease 70,650 34% Diabetes 64,570 31% Depression 53,425 26% Chronic Heart Failure 49,496 24% Arthritis 48,491 23% Behavioral Health 41,863 20% Alzheimer Related Disease 37,872 18% Chronic Obstructive Pulmonary Disease 36,754 18% Chronic Kidney Disease 33,058 16% Cataract 21,852 11% Osteoporosis 20,060 10% Alzheimer's Disease 19,844 10% Over 14% have >six (6) multiple conditions. 8% have five (5) multiple conditions. 10% have four (4) multiple conditions. Over 12% have three (3) multiple conditions. Source: MDCH Stakeholder Meeting Presentation Slides July 2011

13 Basic Dual Eligible (DEs) Demographics Women represent 61.5% of all DEs, and 52.6% of DE women are over the age of 65. Men represent 38.5% of all DEs, and 64.7% are under 65 years of age. Table 1 Gender Age Under 65 Over 65 Total Female 64,539 71, ,264 Male 55,268 30,155 85,423 Total 119, , ,687 Table 2 Gender Age Under 65 Over 65 Total Female 53.9% 70.4% 61.5% Male 46.1% 29.6% 38.5% Total 100.0% 100.0% 100.0% Table 3 Gender Age Under 65 Over 65 Total Female 47.4% 52.6% 100.0% Male 64.7% 35.3% 100.0% Total 54.0% 46.0% 100.0% Source: Medicaid Data Warehouse 2010 Unduplicated Count of Beneficiaries

14 Distribution of Michigan Dual Eligible & MiChoice Enrollees Total Michigan DEs by County n = 213,209 Distribution of MiChoice Enrollees n = 7,848 WAYNE 24% WAYNE, 14.2% ALL OTHER COUNTIES 50% OAKLAND 9% MACOMB 7% KENT 6% ALL OTHER COUNTIES, 65.7% OAKLAND, 8.2% KENT, 6.2% MACOMB, 2.8% GENESEE, 2.9% GENESEE 4% Source: MDCH Data, April 2011

15 Lessons From the Past Enrollment of disabled consumers implementation results demonstrate this is now integral part of managed care in Michigan and has been for more than a decade and highlighted as innovated change in other states. Auto Enrollment of beneficiaries. Assumed to be infringement on choice however implementation result is about 2/3 rd of enrollment making choice and ample opportunity for those auto assigned to make subsequent choice. 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 15

16 Lessons From the Past cont. Mandatory enrollment of pregnant women. Experience in implementation is now matter of course with standards for prenatal care resulting in performance exceeding national averages. Enrollment of foster care children. Experience in implementation again has shown greater access to care and more attention to available services compared to regular fee for service. 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 16

17 Lessons From the Past cont. Provider taxes. Without the oversight and implementation by the Administration, the Medicaid program in Michigan would have received significant reductions years ago its success in developing multiple provider taxes is one the reasons why no eligibility and limited benefit reductions have taken place in Michigan compared to other states. Managed Care. The move from fee-for-service to the physician sponsored plan to managed care were progressive steps all of which were opposed at that time by those supporting the status quo. 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 17

18 Key Consumer Protections That Must be Provided People's right to choose how, where, and from whom they receive care. Access to all services covered by Medicaid and Medicare, as well as enhanced benefits, especially those designed to keep individuals living at home and in the community. Continuity of care allowing access to current providers and services, treatments and drug regimes during a transition process. The ability to appeal decisions and to file complaints about problems encountered in dealing with the program. Meaningful notices and other communications to inform about, for example, enrollment rights and options, plan benefits and rules and care plan elements. 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 18

19 Key Consumer Protections That Must be Provided Culturally and linguistically appropriate and physically accessible services. Access to appropriate providers, who are able to serve the unique needs of dual eligibles. Strong accountability and oversight of the delivery of all services. Payment structures to promote delivery of optimal care, and not reward the denial of needed services. Build on existing structures and delivery systems. 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 19

20 Summary of MAHP Recommendations Area of Concern Integration ICOs Unlicensed & Untested Contractors Summary Recommendation Recommendation: 1. Strategic Plan must incorporate full integration by date certain and move forward by regions based on readiness. 2. Assure that Person Center Planning and implementation be key focus in order to serve the entire health care needs of consumers. 3. Consideration of either exempting or delaying implementation for persons with Developmental Disabilities from this initiative. 4. Integrate State administrative structure to support integrated care. 5. Align effective date with cycle for MA Enrollment no mid year. Recommendation: (Proposal should not result in unintended consequences or use unqualified contractors.) Joint procurement process should only accept bids from licensed entities with requirements to assure: adequate choice of providers fiscal soundness in accordance with NAIC requirements Ability to assume full risk

21 Summary of MAHP Recommendations Area of Concern Technology Platform Provider Reimbursement Regions Summary Recommendation Recommendation: 1. Provision for sharing data between providers and carriers regarding consumer encounters within parameters of HIPAA. 2. Ability to populate electronic medical records, facilitate e- prescribing, lab reports, and handle referrals and authorizations. 3. Electronic access to eligibility and enrollment data 4. Access to state data registries Recommendation: 1. Rates to be based on fiscally and actuarially sound rate assumptions. 2. Establish what constitutes the default reimbursement for providers (i.e., Medicare rates where Medicare is Primary) in the absence of a contract. Recommendation: Use as the framework, the 10 regions established for Medicaid Managed Care in order to facilitate continuity of care for beneficiaries aging into a Dual System and provide access to locally available providers.

22 Michigan Integrating Care for Dual Eligibles Our main priority and focus in this project is providing quality care," said Olga Dazzo, Director of the MDCH. "It is our goal to do this right so that Michigan residents have better access to care that ultimately will provide them with better, more personcentered care."

23 For more information on health reform, please visit MAHP s website ( 5/16/2012 MICHIGAN ASSOCIATION OF HEALTH PLANS 23