MYERS AND STAUFFER LC
AGENDA Federal Focus About Us The Future 2
Federal Focus Better. Smarter. Healthier Strong push to change deliver models across the United States, with the U.S. Department of Health and Human Services leading the efforts. Current State Key Characteristics: Fee-for-Service Payment System Producer Centered Incentives for volume Fragmented Care Unsustainable Future State Key Characteristics: Patient Centered Outcome focused Coordinated Care More sustainable Value-based purchasing Accountable Care Organizations Episode-based payments Medical Home Quality/cost transparency 3
Federal Focus Better. Smarter. Healthier Delivery System Reform requires focusing on the way we pay providers, deliver care, and distribute information. 4
Federal Focus Better. Smarter. Healthier Change the approach to FFS and introduce new models 5
Federal Focus Medicare Readmission Rate Legend: CL: control limit; UCL: upper control limit; LCL: lower control limit 6
Federal Focus Better. Smarter. Healthier Changing the way information enters, accesses and is distributed through the system Electronic Health Records Health Information Exchange Statistical Information Systems Quality Reporting Processes Public Use Data New Technology Standards (FHIR, etc.). 7
ABOUT US TODAY Myers and Stauffer LC: The largest national CPA and consulting firm dedicated to government health programs. Independent, not affiliated with or provide services to any health plans, health care providers or private organizations Guided by strong AICPA professional and ethical standards A long-time partner with 48 State Medicaid agencies Provide services and support to CMS, HHS OIG, FBI, United States Department of Justice, various states Attorney General Experienced in all facets of Medicaid operations / administration A national leader in benefit program design and delivery system reform, audit, reimbursement consulting and rate setting, managed care consulting and auditing, program integrity and compliance, and litigation support Diverse resources and services available to assist our clients Unparalleled expertise and experience within one organization 8
ABOUT US STATE PRESENCE 9
PROGRAM INTEGRITY & MANAGED CARE PRESENCE Area FWAD, RAC, SUR Experience and Services Provided Fraud, Waste and Abuse Detection (FWAD) / Recovery Audit Contractor (RAC) / Surveillance and Utilization Review (SUR) / Medicaid Integrity Contractor (MIC) / Zone Program Integrity Contractor (ZPIC) / Medicare Drug Integrity Contractor (MEDIC) Restricted Card / Lock-in Program / 340B Audits / Pharmacy Audits Expert Witness, Litigation Support and Statistical Services, Claim / Coding Reviews Managed Care MMIS and IT Solutions Quality EHR Financial PERM and Eligibility Testing WIC Managed Care Specialized Audits, Analysis, Operational Reviews, Compliance Reviews, Testing or Special Initiatives Encounter Reconciliation, External Quality Review, Validation, or Databook Audits Pre- and Post-Implementation Medicaid Management Information Systems (MMIS) Audits / Specialized Solutions (e.g. Benefit Testing) / IT Assurance and Risk Solutions DSRIP (Delivery System Reform Incentive Payments), SIM Grant (State Innovation Model Grant), P4P (Pay-for-Performance), Payment Reform Electronic Health Records Incentive Payment Consulting and Audits Cost Report Audits Medicaid Financial Management Payment Error Rate Measurement (PERM) / Practice PERM Eligibility (i.e., off-cycle PERM) Eligibility Audits and Eligibility System Testing Women Infant Children (WIC) / Supplemental Nutritional Assistance Program (SNAP) Audits 10
THE FUTURE DATA, DATA, DATA Infrastructure Improvements Focus on transparency Ensure Growth is Sustainable Work across space to partner at all levels 11
QUESTIONS? Jason McNamara Director, Healthcare Technology Services +1.619.548.4442 JMcNamara@MSLC.com 12