the status of medicaid acos and their projected future · 2018. 6. 20. · the status of medicaid...
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The Status of Medicaid ACOs and their Projected Future
801.538.5082 | [email protected] | 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 [email protected]
• 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
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 | [email protected] | 4001 South 700 East suite 700, Salt Lake City, UT 84107