the status of medicaid acos and their projected future · 2018. 6. 20. · the status of medicaid...

The Status of Medicaid ACOs and their Projected Future

801.538.5082 | info@accountablecareLC.org | 4001 South 700 East suite 700, Salt Lake City, UT 84107

HOUSEKEEPING

• Join the Zoom Webinar on your computer or phone• If you are only able to connect by phone, don’t worry – we’ll send out

the slide deck after the call along with a recording.

• Questions• There will be opportunities for questions in the last 15 minutes, so

please submit them using the question module in the Zoom application.

AGENDA

• ACLC updates

• Introduction of guest presenters

• Presentations by Judith D. Moore, Russ Elbel and moderated by Cristal Gary

• Opportunity for Q&A– Members can submit questions ahead of time by using the

question box of the Zoom window

UPCOMING MEMBER EVENTS

Workgroup meetings – 3rd Tuesday of the month (June 19th)

SAVE THE DATE – ACLC MEMBER MEETINGOctober 23rd - 24th in Washington, D.C.

WORKGROUP MEETINGSWorkgroup meetings – 3rd Tuesday of the month

• Finance: 11am ET• Governance: 12pm ET• Health IT: 1pm ET• Care Delivery: 2pm ET

PRESENTERS

Russ Elbel

Medicaid and CHIP Program DirectorSelectHealth

Judith D. Moore

NAACOs Medicaid AdvisorHealth Policy Consultant

Cristal Gary

PrincipalLeavitt Partners

MEDICAID AND ACOSEVOLUTION AND CURRENT ACTIVITIES

JUDITH D. MOORENAACOS MEDICAID ADVISOR

FOR THE ACCOUNTABLE CARE LEARNING COLLABORATIVEJUNE 7, 2018

MEDICAID ACO BACKGROUND AND EVOLUTION

• State Decision-Making and Administration of Medicaid

• Early Interest Post-ACA

• CMMI/ Medicaid Waivers and Special Programs

• Evolving Models

• Predominance of Medicaid Managed Care (MMC)

CURRENT MODELS USING ACO/ACO-LIKE ENTITIES

• State Contracts with ACOS for Medicaid Beneficiaries

• State Requires MCOs to Contract with ACOs

• Formal and Informal MCO Arrangements with ACOs to provide services for Medicaid beneficiaries

NOTABLE FEATURES

• Adopted as a type of Value Based Purchasing

• Part of Waiver/Delivery System Reforms

• Driving Data and Financial Infrastructure Development

• Need for Careful State Oversight and Administration

• Focus on Social Determinants in Leading States

SOPHISTICATED, SIGNIFICANT ACO MODELS

• Massachusetts

• Minnesota

• Oregon

• Rhode Island

• Vermont

OTHER IMPORTANT ACO/ACO-LIKE PROGRAMS

• Colorado

• Iowa

• Maine

• New Jersey

• New York

• Utah

CHALLENGES

• Need to build unique programs: State delivery system characteristics and idiosyncrasies

• Meshing ACOs and MCOs or other VBP techniques

• Financing and Data Infrastructure

• Oversight – State regulation and staffing

• Social Determinants of Health Focus

• Federal Requirements and Opportunities

SPECULATION ON THE FUTURE

• Fit with Managed Care

• Evaluation, Oversight, Monitoring – Costs and Benefits

• Federal Funding for Delivery System Reform and Waiver Policy

For Further Information…

Center for Health Care Strategies, Princeton NJMedicaid Accountable Care ProjectNumerous basic background resources, as well as special papers, technical assistance tools, blog posts, etc.https://www.chcs.org/topics/medicaid-accountable-care-organizations/

National Association of ACOs (NAACOS)See Website, “Policy and Advocacy – Medicaid ACOs” sectionhttps://www.naacos.com/medicaid-acos

Judith D. MooreNAACOS Medicaid AdviserHealth Policy Consultant703-536-8408judithdmoore@gmail.com

• Established in 1983• Wholly-owned subsidiary of

Intermountain Healthcare• Cover over 800,000 members• Networks - Intermountain and

affiliate providers

• Established in 1975• 22 hospitals• 165 clinics• 800 multi-specialty providers• Formed “to be a model healthcare

system”

ALIGNING INCENTIVESShared Accountability / Risk

Medical Expense

Delivery System

Administrative Expense

Health Plan

Engagement, Integration, and

Innovation

INTEGRATOR ROLE

“An integrator is an entity that accepts responsibility for all three components of the Triple Aim for a specified population”.

“In crafting care, an effective integrator, in one way or another, will link health care organizations (as well as public health and social service organizations) whose missions overlap across the spectrum of delivery”.

CATEGORIES AND OVERLAP OF VULNERABLE POPULATIONS

Lewis V A et al. Health Affairs. Categories and Overlap of Vulnerable Populations In the US Health Care System 2012;31:1777-1785

ADDRESSING HEALTH EQUITYUtah Alliance for Determinants of Health

OBJECTIVES FOR THE DEMONSTRATION Improved health equity in two defined geographies

• Implement and test models of care for the “highly vulnerable”

• Improve access to physical and behavioral health, and social services

• Reduce unnecessary ED visits and resulting admissions• Decrease healthcare spending

DETERMINING THE POPULATIONWhy SelectHealth Medicaid Members?

• Intermountain and SelectHealth are at-risk for the care for this Medicaid population

• Many Medicaid members are considered highly vulnerable clinically and/or socially

• As a state run program, Medicaid affords many opportunities to align with partners at the state, county, and city level

• Partners who serve the Medicaid population also have established efforts and similar interest in addressing the social determinants of health

DETERMINING GEOGRAPHY

1. Population of at least 2,000 SelectHealth Medicaid enrollees

2. Readiness of community partners to be involved in the initiative• Relationships with community partners• Intergenerational Poverty• Existing collaborative efforts

3. Disparities identified by selected criteria

• Hospital readmission rates• Percentage diagnosed with diabetes• Emergency Department usage• Ambulance use for typical outpatient care• Number of adults with disabilities• Percentage with a behavioral health diagnosis

Criteria Weighted Highly

• Percentage with opioid prescriptions • Percentage with substance use disorders• Children with parents on SelectHealth Medicaid• Number of children with disabilities• Number of WIC recipients• Average income and education level

Criteria Weighted Moderately

CRITERIA FOR DETERMINING DISPARITIES

SELECTING GEOGRAPHIES – HOT SPOTTING

ALLIANCE DEMONSTRATION MODEL

Improve Organization of Services

Collaborate with Local Partners

Leverage Digital Health and Analytics to

Engage Members

Innovative Payment Models

Improve Organization of Services

Align, Integrate, and Support Community Partners

Systematically Assess and Address Social Needs

Evaluate and Scale to Other Communities

Local Steering Committees Generate “Collective Impact”

Physical Health

Behavioral Health

Social Determinants

Refer and Navigate to Community Partners

TACO

CHCS, Jan. 2014, and Health Affairs blog, Jan. 23, 2014. Introducing Total Accountable Care Organizations: Thttp://www.chcs.org/media/Introducing-Totally-Accountable-Care-Organizations_Nov2014.pdf.

Total Accountable Care Organization (TACO)

A health care system where all physical health, behavioral health, long-term services and supports (LTSS), and elements of public health and social services are integrated for targeted high-need populations

THISNOT THIS

Q & A

Questions About the ACLC?If you have questions about the ACLC please email

members@accountablecarelc.org

UPCOMING MEMBER EVENTS

Workgroup meetings – 3rd Tuesday of the month (June 19th)

SAVE THE DATE – ACLC MEMBER MEETINGOctober 23rd - 24th in Washington, D.C.

801.538.5082 | info@accountablecareLC.org | 4001 South 700 East suite 700, Salt Lake City, UT 84107