top 10 medicaid spends and trends that need to be fixed · 6 top 10 medicaid spends and trends that...
TRANSCRIPT
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Top 10 Medicaid Spends and Trends That Need to be Fixed
Jeffery Thompson, MD MPHWashington State Medicaid
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Washington State Medicaid will pay vaginal rates for •DRG 371‐CESAREAN SECTION W/O CC and •DRG 373‐VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES
10: Medicaid delivers 50% of U.S. infants –we can do better than a 10% increase in C-
sections annually
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9: Medicaid’s pharmacy budget is 85% brand – we need better value with generics
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8: Medicaid Clients use the ER for non-Emergent Conditions: Changes in benefits can the management needed but we need to
give communities tools
0
500
1000
1500
2000
2500
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3500
4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738394041424347484950515457656667708292
Num
ber o
f Clients
Visits per Client
Medicaid Purchasing Administration ER Proposal > 3 Emergency Room Non‐Emergent Visit Frequency
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7: Medicaid is the largest payer of Mental Health Drugs and Substance Abuse Treatment– we can do better by giving provider feedback and using
EMR effectively
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The MMDLN Motto Shameless Sharing and Stealing
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6: Medicaid’s spends 25% of the pharmacy budget on AAP – we need to define “Too Much”
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5: Medicaid’s Medical Homes are models for better value: if you can change client,
provider and system behaviors
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4: Medicaid has high readmission rates –we need to keep them out of hospitals
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3: Five percent of our clients are responsible for 50 percent of our costs –
we need better chronic care management.
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2: Twenty percent of Medicaid providers see 80% of our patients
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And the No. 1 spend and trend that needs
to be fixed….
12
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13
1: Medicaid wastes approximately one-third of its spending on services have lower value: Evidence
Benefits, Rates and Policies are Possible
Zero co-payments• Vaccines • Generic Drugs• Low cost •Technology with evidence Higher Co-payments
• Brand drugs with generics• Least costly brand• New technology without
evidence
Zero 25% 50% 75% 95%Increasing Cost Sharing or change the Rates
Incr
easi
ng le
vels
of e
vide
nce
A
B
C
D
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Take your Medical Director to Lunch
Questions?