Investing in Quality: Medicaid OpportunitiesOklahoma Health Care Authority Board Retreat

August 27, 2009

Melanie BellaSenior Vice PresidentCenter for Health Care Strategies

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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.

► Our Priorities Improving Quality and Reducing Racial and Ethnic Disparities Integrating Care for People with Complex and Special Needs Building Medicaid Leadership and Capacity

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CHCS Funding Partners• Aetna Foundation• Agency for Healthcare Research and Quality • The Annie E. Casey Foundation• California HealthCare Foundation• Colorado Health Foundation • The Commonwealth Fund• Kaiser Permanente• New York State Health Foundation • Robert Wood Johnson Foundation

THECOMMONWEALTH

FUND

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Medicaid’s Fast Facts

67 million People in the United States who will receive Medicaid benefits in 2009.

$364 billion Estimated 2009 costs for Medicaid.

1 million Number of additional Medicaid/CHIP beneficiaries resulting from a 1% increase in unemployment.

41% Births in the U.S. covered by Medicaid.

27% Children in the U.S. covered by Medicaid.

27% Percentage of total mental health costs financed by Medicaid.

41% Percentage of total long-term care costs financed by Medicaid.

4% Percentage of beneficiaries accounting for 50% of total Medicaid spending.

8.8 millionPeople who are dually eligible for Medicare and Medicaid, including low-income elderly and people with disabilities.

11 millionCBO estimate of additional people to receive Medicaid coverage under the House bill, with Medicaid and CHIP provisions estimated at $438 billion over the next decade.

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Medicaid’s Role for Selected Populations

Note: “Poor” is defined as living below the federal poverty level, which was $17,600 for a family of 3 in 2008. SOURCE: KCMU, KFF, and Urban Institute estimates; Birth data: NGA, MCH Update.

65%

44%

20%

51%

23%

40%

19%

20%

27%

27%

41%

24%

Nursing Home Residents

People Living with HIV/AIDS

People with Severe Disabilities

Medicare Beneficiaries

Births (Pregnant Women)

Low-Income Parents

Low-Income Children

All Children

Hispanics

African-Americans

Near Poor

Poor

Percent with Medicaid Coverage:

Families

Aged & Disabled

CHCS: Accelerating Innovation in Medicaid

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Multiple providers No coordination Lack of patient focus Inadequate information

sharing No accountability Unaligned payment

Accountable medical home Coordinated care for

patients with complex needs Patient-centered care Information exchange Performance measures Incentives/aligned financing

Fragmented Care

Integrated System

Ways States are Coordinating Care for Beneficiaries with Complex Needs

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Primary Care Case Management, Administrative Service Organizations, etc.

Alternative Models

Disease Management; Chronic Care Management; Medical Home

FINANCING OPTIONS

Care Management Approaches

Feefor

Service

Full-RiskManaged

Care

Oklahoma Medicaid’s “Learning Laboratories”

Reducing Disparities at the Practice Site ► Target small provider practices (10) with high volume of minority patients for

practice-site quality improvement► Stakeholder team includes Oklahoma Health Care Authority, Iowa Foundation for

Medical Care, and APS Health Systems

Medicaid Leadership Institute ► 12-month executive training focused on policy, technical, and leadership skills ► Position directors to maximize Medicaid’s contribution to national health system

transformation► Lynn Mitchell, MD, is in the inaugural class

Return on Investment Purchasing Institute ► Build state capacity to forecast the financial returns that may be generated by

investments in quality improvement► OK Medicaid used projected savings for people with diabetes in the Health

Management Program (HMP) to gain stakeholder support ► Currently calculating ROI for emergency room utilization program

Care Management for Complex Populations► Early innovator in development of HMP for high-need, high-cost beneficiaries

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Reform Status: House

• Tri-Committee Bill – Passed by all 3 Committees► Expands Medicaid to 133% FPL for all Americans► Individual and Employer Mandates► Insurance Exchange with Public Plan Option

• Blue-Dog Amendments► States Pay for 10% of Medicaid Expansion Beginning

in 2015► Center for Medicare and Medicaid Payment

Innovation

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Reform Status: House

• Leadership Crafting Bill for House Floor► Delicate Balancing Act between Blue Dogs and

Progressive Democrats► CBO Score Plays Vital Role► Town Hall Impact

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Reform Status: Senate

• Health Education Labor and Pensions (HELP) Committee Bill – Passed out of Committee

► Expands Medicaid to 150% FPL for all Americans► Individual and Employer Mandates► Insurance Exchange with Public Plan Option

• Finance Committee – No Bill, Only Policy Options► Gang of Six Negotiations – Deadline September 15► Exchange with Cooperatives► Unknowns - Medicaid Expansion % of FPL, and State

Share of Financing

Reform Status: Timeline

• September► House Floor Vote► Senate Finance Committee Markup

• October ► Senate Floor Vote► Conference Committee

• To Be Determined► House and Senate Votes on Conference Committee

Compromise

Reform Status: Wild Cards

• Public Opinion► “Government-Run” Health Care► End-of-Life Provisions

• Continuing Industry Support ► PhRMA Deal► AMA, AHA, AHIP, etc.

• Budget Reconciliation

Reform Considerations for Oklahoma

• Medicaid Expansion ► How Many Beneficiaries?► How Quickly?► Who’s Paying?► Movement into Exchange?

• Potential Impact on Insure Oklahoma• Medicaid (and Medicare) Financing Reform• State Role in Exchange, Public Plan or

Cooperatives

Visit CHCS.org to…

► Download practical resources to improve the quality and efficiency of Medicaid services.

► Subscribe to CHCS eMail Updates to find out about new CHCS programs and resources.

► Learn about cutting-edge state/health plan efforts to improve care for Medicaid’s highest-risk, highest-cost members.

www.chcs.org

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