COMMONWEALTH OF KENTUCKY Medicaid IT IT Tra ransformation HMA Conference October 1, 2018
IT Transformation - Agenda IT Topic Content • What is Kentucky HEALTH • The need for Kentucky HEALTH Kentucky HEALTH • Partners • Component & Technology Integrated Eligibility and Enrollment • Integrated Benefit Programs Solution (IEES) Medicaid Enterprise Management • Modularity Solution (MEMS) • Best Practices Experiences • Lessons Learned • Q&A Session Questions
What is is Kentucky HEALTH 3
Kentu tucky Healt lth Program Overview Kentucky HEALTH is the Commonwealth’s new program for certain low -income adults and their families. The program gets its name from its mission. H E A L T H Helping to Engage & Achieve Long Term Health This innovative program brings together existing state agencies and programs, and leverages federal funding to improve member access to health , educational, financial, and professional development resources that can help families and communities grow and thrive over the long- term .
The need for r Kentucky HEALTH 5
Chall llenges Facin ing Kentu tucky Nationally, Kentucky is ranked close to last in many crucial areas. The state’s unemployment rate, poverty rate, workforce participation rate, and wages are all significantly below the national average. Over the past decade, the opioid Kentucky is among the worst nationally epidemic has wreaked havoc on our in several key population health families, communities and economy. metrics. • Overdose deaths have climbed to • 1 st in the nation for cancer deaths, 2 nd more than 1,000 per year. highest in the nation for smoking. • Kentucky’s rate of babies born drug - • Over 1/3 of Kentuckians have weight- related health issues (7 th highest rate addicted is twice the national average. in the nation). • Drug abuse has negative impacts on • There are 6.9 infant deaths per 1,000 live births (13 th highest rate in the daily life and work functions, is weakening family and social nation). connections, and is impacting • Recent report shows 8 of 13 counties employability (attendance, teamwork, in the nation with largest declines in and productivity). life expectancy since the 1980s are in • All of these factors impact a person’s Kentucky. ability to be independent.
Unsustainable Growth • High poverty & high Medicaid enrollment Workforce participation rate is 59.4% (45 th in the nation) • • 19% of Kentuckians live in poverty 47 th in the nation for median household income • • Nearly 1/3 of total state population is enrolled in Medicaid • Kentucky has poor health outcomes despite high spending • 1 in 3 Kentuckians struggle with weight-related health issues Ranks 2 nd highest in the nation for smoking • Ranks 1 st highest in the nation for cancer deaths • • No long term financing plan • Kentucky is projected to spend approximately $1.2 billion over the next five years on expanded Medicaid benefits (SFY 2017-2021) The cost growth in Medicaid expansion threatens funding for traditional Medicaid coverage for pregnant women, children, and individuals who are aged, blind, or have disabilities.
How Did We Get Here? Where is is Kentu tucky compared to oth ther states KENTUCKY RANK 45 th FREQUENT MENTAL DISTRESS 44 CANCER DEATHS 50 PREVENTABLE HOSPITALIZATIONS 50 CHILDREN IN POVERTY 46 SMOKING 49 DRUG DEATHS 48 FREQUENT PHYSICAL DISTRESS 48 OBESITY IN ADULTS 46 PREMATURE DEATH/100,000 44 CARDIOVASCULAR DEATHS/100,000 43 PHYSICAL INACTIVITY 47 DIABETES IN ADULTS 47 LACK OF HEALTH INSURANCE 10 HIGH SCHOOL GRADUATION 8 America’s Health Rankings 2016
Kentu tucky HEALTH Program Kentucky’s Section 1115 Waiver is referred to as Kentucky HEALTH: H elping to E ngage & A chieve L ong T erm H ealth Encourages members to 1 Kentucky HEALTH will empower people to improve their health by seek and gain employment and transition to incentivizing preventative self sufficiency, will encourage healthy care riple-Aim Approach lifestyles by incentivizing tangible actions with actual rewards, and will ensure long- term fiscal sustainability for Kentucky Embraces private 2 taxpayers market policies to prepare members for the commercial market Trip 3 Addresses growing drug abuse epidemic
What Determines Healt lth? Clinical Care (20 %) Healthy Behaviors (30%) Social & Economic Factors (40%) Access to healthcare alone will NOT dramatically improve the health of Kentuckians. Kentucky HEALTH seeks to provide a holistic solution to improve member health. Note: The remaining 10% accounts for miscellaneous factors.
Who is is in involved in in Kentucky HEALTH 11
Who is is in in th the overall l Kentu tucky HEALTH pic icture? DMS, Public Health, CMS, Governor’s Office, DCBS, Behavioral Cabinet for Health and Multiple technology Family services, Education Health, and many Partners (Deloitte, & Workforce Cabinet other state offices DXC, etc.) help in decide Kentucky HEALTH help build and implementing these support these policies policies policies Kentucky Medicaid Frontline staff - recipients will Managed Care caseworkers, benefit from these Organizations will provide Assisters - help new policies with benefits based on the citizens understand overall improved newly implemented and use these health. policies policies.
Forces working towards Kentucky HEALTH’s success Government Contracted Support Vendors Agents Kentucky Governor's Office Deloitte Navigators Cabinet for Health and Family DXC Technology Conduent (Call Center) Services HMA Medicaid Market Solutions Regional Entities (local government agencies, Wakely Members community resources, etc.) Medicaid Recipients in the State Education & Workforce Cabinet Department for Community Based External Partners MCOs Services Aetna, Anthem, Humana, Department for Medicaid Employers/ Passport, WellCare Services Businesses Adult Education Providers (Dental/Vision & Evaluators General) Department of Public Health UPENN/Center for Health Organizations (Professional Incentives and Behavioral Associations, Advocacy Groups) Legislators Economics Media Workforce Innovation Boards NORC at the University of (state & local) Chicago
Kentucky HEALTH Component & Technology 14
Key Components of Kentu tucky HEALTH Deductible Account The deductible account empowers individuals Cost Sharing to make cost-conscious healthcare decisions. Cost sharing introduces members to critical My Rewards Account commercial market My Rewards Account features, including making provides incentives for timely monthly premiums, members to improve their tracking deductibles, and health, engage in their managing a healthcare communities, and improve account a way of investing their job skills. in own health. Kentucky PATH Program HEALTH Research shows an important link between some sort of community engagement (like volunteer work, public service, and Employer employment) and an Sponsored individual’s overall health and well-being. This Insurance (ESI) program is a unique Establishes a path for the Education and community engagement state to pay member’s and employment initiative Training premium if employer for Kentucky HEALTH sponsored insurance is The Health and Financial members designed to build available. Literacy classes allow and strengthen Kentucky’s Kentuckians to gain skills workforce. for long-term independence and success.
Technolo logy Partner Systems in in Kentu tucky HEALTH Partner Systems Kentucky HEALTH Integrated Eligibility and Enrollment Solution (IEES) has the following Core Eligibility & Enrollment system (benefind) that determines, core partner captures , and stores member benefits. systems that help Medicaid Management Information System (MMIS) in reaching the Member and Provider Management module with components goals for this such as Medicaid Claims Processing and provider access via HealthNET. program. Managed Care Organization (MCO) Systems Medical service provider that offers managed care health plans and additional medical services at reduced/no cost to members. My Rewards Solution Provides access to enhanced benefits through a Health Savings/Reimbursement Account. Path (Community Engagement) Solution Tracks Community Engagement hour requirements for qualifying members and provides opportunities to engage in relevant activities. Employer Sponsored Insurance (ESI) Solution Responsible to verify if an Employer Sponsored Insurance (ESI) is cost effective and comprehensive based on which members would be encouraged to enroll in their ESIs.
Prim imary In Innovations in in Kentu tucky HEALTH Innovation #1: First of its kind Community Engagement component Innovation #3: Innovation #2: Nudging Medicaid recipients towards Encouraging healthy lifestyles by desired outcomes incentivizing health actions
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