3/3/2017 Medicaid Trends and MassHealth System Transformation HFMA March 10, 2017 H EALTH M ANAGEMENT A SSOCIATES Agenda The National MCO and Reform Context The Changing MassHealth Delivery System Looming State and Federal Issues Discussion 2 1
3/3/2017 Medicaid Spending and Enrollment Growth Over Time Annual Percentage Changes, FY 1998 – FY Total Medicaid Spending Medicaid Enrollment 13.2% 12.7% 10.4% 10.5% 9.7% 8.5% 8.7% 9.3% 7.8%7.2% 7.7% 6.8% 7.5% 6.8% 6.4% 5.6% 5.9% 5.8% 4.7% 7.6% 4.5% 4.3% 3.8% 3.2% 3.2% 6.6% 5.3% 3.2% 2.3% 1.3% 4.8% 3.9% 3.3% 3.1% 0.4% 1.5% 0.2% ‐ 0.5% ‐ 1.9% ‐ 4.0% 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Proj. NOTE: For FY 1998 ‐ 2013, enrollment percentage changes are from June to June of each year. FY 2014 ‐ 2016 reflects growth in average monthly enrollment. Spending growth percentages refer to state fiscal year. FY 2017 data are projections based on enacted budgets. SOURCE: Kaiser Family Foundation, Medicaid Enrollment & Spending Growth: FY 2016 & FY 2017 ; October 2016, available at: http://kff.org/health ‐ reform/press ‐ release/50 ‐ state ‐ survey ‐ finds ‐ slower ‐ growth ‐ in ‐ total ‐ medicaid ‐ spending ‐ nationally ‐ in ‐ fy ‐ 2016 ‐ and ‐ projected ‐ for ‐ fy ‐ 2017 ‐ as ‐ earlier ‐ increases ‐ from ‐ the ‐ affordable ‐ care ‐ acts ‐ coverage ‐ expansions ‐ taper ‐ off/ 3 Medicaid Expansion Decisions by Year of Implementation VT WA ME ND MT* NH* MN MA OR NY WI* SD ID MI* RI CT WY PA NJ IA* NE OH DE IL IN* NV MD UT WV VA CO DC KS MO KY CA NC TN OK SC AR* AZ NM AL GA MS AK LA TX FL HI Implemented in FY 2014 (26 States including DC) Implemented in FY 2015 (3 States) Implemented in FY 2016 (2 States) Implemented in FY 2017 (1 State) Not Implementing At This Time (19 States) NOTES: *AR, IA, IN, MI, MT, and NH have approved Section 1115 waivers. WI covers adults up to 100% FPL in Medicaid, but did not adopt the ACA expansion. SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, October 2016. 4 2
3/3/2017 National Medicaid Enrollment and Spending Growth Expansion States Non ‐ Expansion States 19.3% Median Rates of Growth 10.3% 7.1% 4.8% 4.2% 3.9% 3.8% 3.5% 2.6% 2.2% 1.1% 1.2% 2015 2016 2017 Proj 2015 2016 2017 Proj Medicaid Enrollment Total Medicaid Spending NOTE: Percentages reflect the median percent change for each group of states for each year. FY 2017 growth reflects projections in enacted budgets. In FY 2016, Alaska and Montana moved and in FY 2017, Louisiana moved to the expansion state group. SOURCE: Enrollment growth for FY 2015 ‐ 2016 is based on KCMU analysis of CMS, Medicaid & CHIP Monthly Applications, Eligibility Determinations, and Enrollment Reports, accessed October 2016. The spending growth rate for FY 2015 is derived from KCMU Analysis of CMS Form 64 Data. All other growth rates are from the KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, October 2016. 5 In 2016, at least 75% of all Medicaid beneficiaries are in an MCO in 28 states (up from 21 states in 2015) Excluded <25% 25 ‐ 49% 50 ‐ 74% 75+% 13 28 32 34 8 25 9 4 9 3 1 3 5 1 1 2 2 1 1 1 All Beneficiary Groups Children ACA Expansion Adults All Other Adults Elderly and 39 states 39 states 27 states 39 states Disabled 39 states NOTES: Limited to 39 states with MCOs in place on July 1, 2016. Of the 32 states that had implemented the ACA Medicaid expansion as of July 1, 2016, 27 had MCOs in operation. SOURCE: Kaiser Commission on Medicaid and the Uninsured Survey of Medicaid Officials in 50 states and DC conducted by Health Management Associates, October 2016. 6 3
3/3/2017 Managed Care is Medicaid’s Predominate Delivery System As states expect MCOs to develop alternative 39 states today have MCO • contracts payment models, what will result? 25 of 27 Medicaid expansion More mergers/integration with provider • • states are using managed care to systems? cover the expansion population Poorly integrated demands on providers? • Collaboration or competition with ACOs? • Increasingly states are • When this involves Medicare, will MCOs be extending managed care to expected to follow Medicare’s MACRA Long Term Services and imperatives? Supports MCOs will need to transition from payers to implementers of state ‐ led delivery system reforms. Providers will need to deal with multiple demands for APMs 7 Agenda The National MCO and Reform Context The Changing MassHealth Delivery System Looming State and Federal Issues Discussion 8 4
3/3/2017 MassHealth Delivery System Reform The push for innovation in MassHealth’s delivery system is on. CMS and EOHHS are (or perhaps were) aligned. • MassHealth wants fundamental delivery system reforms • CMS wants measurable system ‐ wide transformation Fee ‐ for ‐ service payment models encourage volume and fragmentation • MassHealth costs too much and is growing too fast • ACOs will re ‐ organize the care delivery system • • MCOs play a role alongside the new entities, on an as ‐ needed basis • The PCC Plan in its current form is being eliminated • ACOs will forge partnerships with community ‐ based resources • The ACO model requires that PCPs can join only one ACO Meanwhile, the state will be accountable to CMS for hitting target statewide trends for cost, utilization and quality . 9 The Broader MassHealth Picture Integrated Care Models Program Integrity for ACOs with Medicare LTSS • 3 distinct models to • Existing programs for • New third party accommodate risk Medicaid ‐ Medicare administrator to focus readiness and provider “duals” are favored and on LTSS services not in circumstances likely to expand managed care • Plan to move LTSS • SCO (over 65) • Emphasis is on program services into ACOs in integrity and admin • OneCare (under 65) Year 3 resources, but program • PACE will likely evolve to • Big emphasis on social support programmatic determinants goals • Social risk adjustment • Flexible services funds • Community partners Constant budget challenges are the backdrop for ALL of this transformation work. 10 5
3/3/2017 ACOs could be an option for 2/3 of MH members IN MassHealth’s Current Delivery System 67% of MassHealth members are in non ‐ dual managed care: MCO • PCC Plan • CarePlus MCO • MCO [CELLREF], 31% [PERCENTA GE] OUT PACE <1% 20% have other insurance (Medicare or employer) Duals not in managed care SCO • Individuals with commercial <2% • coverage CarePlus Individuals enrolled in HCBS • MCO waivers One Care PCC Plan 13% <1% 23% 13% are in SCO, OneCare or MassHealth Limited SOURCE: MMPI, MassHealth: The Basics, Facts and Trends; Enrollment Update as of September 2016 11 Accountable for what? • ACOs are financially accountable for physical and behavioral health services and covered prescription drugs Essentially what MCOs cover today • Significant interest in dealing with MassHealth state plan LTSS costs , but • a recognition that ACOs are not prepared to deal with this immediately • Financial accountability means a range of potential payment mechanisms and risk arrangements – and all must have some accountability for quality performance Shared Savings • Shared Savings and Risk • Capitation ‐ PMPM • • Other ACO expectations will include creating value ‐ based purchasing arrangements at the provider level. How the MCOs fit into this picture is a very big TBD. How providers fit in is easy: more risk at the provider level. 12 6
3/3/2017 A Bunch of Connected Procurement Processes • Implementing the plans means conducting a series of procurements • Pilot ACOs began providing services in December 2016 • Full ACO application process is underway – state is evaluating responses • MassHealth also planning a regional procurement of Certified Community Partners (CPs) • MCO contracts will be awarded consistent with the ACO plan We Extension ACO Pilot ACO/ are request Launch MCO/CP here Launch Services July 22, December begin 2016 2016 Oct 2017 ACO RFR CP DSRIP MCO RFR January Released Released Certification Funding 2018 Process Starts September Late 2016 2016 March 2017 July 2017 13 Agenda The National MCO and Reform Context The Changing MassHealth Delivery System Looming State and Federal Issues Discussion 14 7
3/3/2017 BLOCK GRANTS 15 Medicaid Block Grants or Per Capita Caps: a Fundamental Change in Medicaid Financing • Medicaid block grant: a fixed amount of federal funds to each state, regardless of actual Medicaid costs in that state o The fixed amount would be based on baseline historical federal spending for each state o The fixed block grant amount would be adjusted annually by an index • Per capita cap: a variation of a block grant, but the fixed amount is per enrollee o Usually, proposals set the fixed amount by eligibility category (e.g., children, adults, aged or disabled) o The per capita cap allows federal funds to increase or decrease with changes in enrollment The basic equation: (PER ‐ PERSON SPENDING) X (PEOPLE) = FEDERAL GRANT 16 8
Recommend
More recommend
