Medicaid Redesign, Delivery System Reform, Managed Long Term Care Workforce Program Kalin Scott Director, Medicaid Redesign Team Project Management Office December 2016
December 2016 2 New York State Medicaid Nearly 6.2 million individuals in New York State are Medicaid members (ranking 2 nd in the nation, after CA) Current Medicaid spend in New York State is approximately $59 billion annually (also 2 nd in nation)
December 2016 3 NYS Medicaid in 2010: the crisis > 13% anticipated growth rate had become unsustainable, while quality outcomes were lagging 2009 Commonwealth State Scorecard on Health System Performance Costs per recipient were double the national average NYS ranked 50 th in country for avoidable hospital use 21st for overall Health System Quality Attempts to address situation had failed due to divisive political culture around Medicaid and lack of clear strategy CARE MEASURE Avoidable Hospital Use and Cost Percent home health patients with a hospital admission Percent nursing home residents with a hospital admission Hospital admissions for pediatric asthma Medicare ambulatory sensitive condition admissions Medicare hospital length of stay NATIONAL RANKING 50 th 49 th 34 th 35 th 40 th 50 th
December 2016 4 Creation of Medicaid Redesign Team A Major Step Forward In 2011, Governor Cuomo created the Medicaid Redesign Team (MRT). Made up of 27 stakeholders representing every sector of healthcare delivery system Developed a series of recommendations to lower immediate spending and propose reforms Closely tied to implementation of Affordable Care Act in NYS The MRT developed a multi-year action plan we are still implementing that plan today
December 2016 5 Key Components of MRT Reforms Global Spending Cap Introduced fiscal discipline, transparency and accountability Limit total NYS Medicaid spending growth to 10 year average rate for the long-term medical component of the Consumer Price Index (currently estimated at 3.6 percent). Care Management for All NYS Medicaid was still largely fee for service; moving Medicaid members to managed care helped contain cost growth and introduced core principles of care management Patient Centered Medical Homes and Health Homes Stimulating PCMH development and invest in care coordination for high-risk and highcost patients through the NYS Health Homes Program Targeting the Social Determinants of Health Address issues such as housing and health disparities through innovative strategies (e.g. promoting member incentives and contracting with community based organizations).
December 2016 6 The 2014 MRT Waiver Amendment Continues to further New York State s Goals Part of the MRT plan was to obtain an 1115 Waiver Amendment which would reinvest MRT generated federal savings back into New York s healthcare delivery system In April 2014, New York State and CMS finalized agreement on the MRT Waiver Amendment Allows the State to reinvest $8 billion of $17.1 billion in Federal savings generated by MRT reforms Programs include DSRIP, MLTC Workforce, Health Homes, and BH HCBS services The waiver will: Transform the State s Health Care System Bend the Medicaid Cost Curve Assure Access to Quality Care for all Medicaid Members Create a financial sustainable Safety Net infrastructure
December 2016 7 The DSRIP Challenge Transforming the Delivery System Largest effort to transform the NYS Medicaid health care delivery system to date From fragmented and overly focused on inpatient care towards integrated and community focused From a re-active, provider-focused system to a pro-active, patient-focused system Allow providers to invest in changing their business models Patient-Centered Transparent Collaborative Accountable Value Driven Improving patient care & experience through a more efficient, patient-centered and coordinated system. Decision making process takes place in the public eye and processes are clear and aligned across providers. Collaborative process reflects the needs of the communities and input of stakeholders. Providers are held to common performance standards and timelines; funding is directly tied to reaching program goals. Focus on increasing value to patients, community, payers and other stakeholders.
December 2016 8 MRT Waiver Amendment: Managed Care Contract Amendments ovehicle to implementing: 1. Long Term Care Workforce Strategy 2. 1915i (BH HCBS) Services 3. Care Restructuring Enhancement Pilots ofunds will flow to plans who will be required to contract for those services. oplans for how funds will be used will be pre-approved by the state. oprograms are under development
December 2016 9 MLTC Workforce Program overview: Authority granted through April 2014 MRT Waiver Amendment to the state s 1115 waiver $245 Million investment through March 2020 Supports initiatives to retrain, recruit and retain workers in the long term care sector Requires collaboration between DOH, MLTC plans and providers, and Workforce Centers of Excellence
December 2016 10 MLTC Workforce Program purpose: New York will require MLTC/FIDA plans to contract with DOH-designated Workforce Centers of Excellence, to: Train needed workers to care for populations benefitted by the MRT Waiver amendment program and Affordable Care Act (ACA) initiatives Invest in initiatives to attract, recruit and retain LTC workers in areas they serve Address reductions in health disparities by focusing on the placement of LTC workers in underserved communities Support the expansion of home care, and respite care, enabling those in need of LTC services to remain in their homes and communities
December 2016 11 MLTC Workforce Program Roles: DOH: Designate Workforce Centers of Excellence through qualification process Identify criteria and process; post for public comment Convene stakeholders for feedback Monitor program progress and report to CMS MLTC/FIDA plans: Contract with Workforce Center(s) of Excellence Convene regional stakeholders Coordinate with providers within region Report to DOH on programming and performance
December 2016 12 MLTC Workforce Program Roles: Workforce Centers of Excellence Demonstrate experience & expertise in delivering trainings to qualify through DOH process Contract with MLTC plans to deliver trainings Work with MLTC plans to develop menu of trainings and convene stakeholders Report on trainings and provide feedback Get the word out on trainings Providers Provide feedback throughout process Ensure employees receive trainings
December 2016 13 MLTC Workforce Workforce Development Initiatives: Each Workforce Center of Excellence will offer a menu of initiatives that address needs of LTC plans, providers and workers in the region Initiatives should align with other key New York programs: DSRIP, SHIP, etc. Should be designed to help advance overall DSRIP goal of reducing avoidable hospital use
December 2016 14 MLTC Workforce Workforce Development Initiatives: Potential topics see handout Initiatives need to address the needs of plans, providers and workers consistent with program objectives Initiatives will be refined through regional stakeholder engagement potential Workforce Centers of Excellence will be asked to offer preliminary approach Applicants will be encouraged to consult with entities including MLTC/FIDA plans, long term care providers, educational institutions, and labor representatives
December 2016 15 MLTC Workforce Next Steps: Finalize approach on financing and performance evaluation DOH regulatory process CMS approval of protocol Create MLTC Workforce advisory group Solicit feedback from stakeholders Will announce program approval through MRT listserv sign up!
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Questions? Additional information available at: https://www.health.ny.gov/mrt https://www.health.ny.gov/dsrip Contact: Kalin.Scott@health.ny.gov Follow MRT on Twitter! @NewYorkMRT