Californias Health Care Coverage California s Health Care Coverage - PowerPoint PPT Presentation

California’s Health Care Coverage California s Health Care Coverage Initiative: County Successes and a Look Ahead to Health Reform to Health Reform Caroline Davis, Senior Consultant April 14, 2010 cdavis@healthmanagement.com d i @h lth t

Overview of HMA s HCCI Work Overview of HMA’s HCCI Work • Funded by TCE and CHCF to work with HCCI over last 2 years: • Provided technical assistance to HCCI counties • Conducted qualitative assessment of lessons C d t d lit ti t f l learned and identified consideration for future extension or expansion extension or expansion • Co-leading Medi-Cal HCCI Technical Work Group as part of waiver renewal Group as part of waiver renewal 1

2 Technical Assistance Project

Technical Assistance Project Technical Assistance Project • Worked with 10 HCCI counties on financial • Worked with 10 HCCI counties on financial sustainability and redesign of indigent delivery systems y • Convened two-day Leadership Summit in January 2009 y • Provided county-specific TA to three counties: • Orange: focused on specialty referrals and g p y network development • San Diego, San Mateo: focused on financial g sustainability 3

County-Specific TA Overview County Specific TA Overview • Counties operate different HCCI programs • Counties operate different HCCI programs, delivery systems • HMA teams reviewed current county HMA teams reviewed current county operations, interviewed stakeholders • Provided recommendations tailored to each Provided recommendations tailored to each county’s interests • Recommendations reinforce need to: • Move away from “silos” • Coordinate care • Collaborate with stakeholders 4

5 HCCI Successes

HCCI is Unique HCCI is Unique • HCCI is unprecedented and unique across the • HCCI is unprecedented and unique across the states • All 10 counties have made remarkable strides All 10 counties have made remarkable strides in 2-1/2 years • Strong local commitment to system Strong local commitment to system innovations and improvements • HCCI focuses on issues critical to health reform implementation and on-going success • Offers lessons for Medi-Cal and national health reform 6

HCCI Has Been A Success HCCI Has Been A Success • HCCI has: • HCCI has: • Expanded coverage to medically-indigent adults • Driven innovation e o at o • Supported reform of local delivery systems • MI adults enrolled in organized system of care with: • A medical home • Defined benefits package • A Access to chronic care management services t h i t i 7

HCCI’s Promising Results HCCI s Promising Results • • Improvements in system efficacy: Improvements in system efficacy: • Clinic operations • • Coordinated specialty referrals Coordinated specialty referrals • Information exchange across providers • Expanded network capacity (public-private) • Key Outcome: Reform impact is significant and goes beyond target population 8

Sustainability Has Been A Challenge • State county fiscal crises have significant • State, county fiscal crises have significant implications • Pressure to reduce spending Pressure to reduce spending • Number of MIAs increasing • Significant pent-up demand for services, even among enrollees known to county systems g y y • Care management strategies are beneficial but may be cost-effective only over time 9

HCCI Key Elements HCCI Key Elements • Implementation of formal eligibility and • Implementation of formal eligibility and enrollment process considered crucial to continuity of care y • Integration of care with emphasis on primary and preventive services coordinated through p g the medical home • Enhancement of capacity and operation of local provider networks to assure access • Use of health IT as foundation for system redesign and successful operation 10

11 Looking Ahead to Looking Ahead to Health Reform

HCCI: Bridge to Health Reform? HCCI: Bridge to Health Reform? • HCCI enrollees qualify for Medi-Cal expansion HCCI enrollees qualify for Medi Cal expansion (to 133% FPL) or Exchange (133-200% FPL) • Medicaid funding could begin April 2010 g g p • CA could implement Medicaid funding via HCCI in new waiver • Automatically meets “budget neutrality” • Spending limited by available local dollars Spe d g ted by a a ab e oca do a s • Could be structured to limit county risk • Early adoption would help maximize federal Early adoption would help maximize federal funding in 2014 (100% FMAP) 12

Health Reform: Key Policy Questions • • Should HCCI focus only on Medicaid expansion Should HCCI focus only on Medicaid expansion population? • Should HCCI expand to new counties? Within p existing counties? • How can HCCI, Medi-Cal, Exchange be synchronized to allow easy transitions in 2014? • How will Medi-Cal expansion be done in 2014? • What happens to HCCI, Section 17000 CC S requirement in 2014? • • How will access issues be addressed? How will access issues be addressed? 13

Final Thoughts Final Thoughts • • Counties have shown strong support to Counties have shown strong support to continue HCCI • Counties used HCCI to consolidate build on Counties used HCCI to consolidate, build on earlier efforts to improve health system operations p • Organized system of care key to sustainability over longer-term • Counties well-positioned to help lead health reform implementation in CA 14