The Status of Medicaid ACOs and their Projected Future 801.538.5082 | info@accountablecareLC.org | 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 – 3 rd Tuesday of the month (June 19 th ) SAVE THE DATE – ACLC MEMBER MEETING October 23 rd - 24 th in Washington, D.C.
WORKGROUP MEETINGS Workgroup 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 Director SelectHealth Cristal Gary Principal Leavitt Partners Judith D. Moore NAACOs Medicaid Advisor Health Policy Consultant
MEDICAID AND ACOS EVOLUTION AND CURRENT ACTIVITIES JUDITH D. MOORE NAACOS MEDICAID ADVISOR FOR THE ACCOUNTABLE CARE LEARNING COLLABORATIVE JUNE 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 NJ Medicaid Accountable Care Project Numerous 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” section https://www.naacos.com/medicaid-acos Judith D. Moore NAACOS Medicaid Adviser Health Policy Consultant 703-536-8408 judithdmoore@gmail.com
Established in 1983 Established in 1975 • • Wholly-owned subsidiary of 22 hospitals • • Intermountain Healthcare 165 clinics • Cover over 800,000 members 800 multi-specialty providers • • Networks - Intermountain and Formed “to be a model healthcare • • affiliate providers system”
ALIGNING INCENTIVES Shared Accountability / Risk Engagement, Integration, and Medical Administrative Innovation Expense Expense Health Plan Delivery System
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 EQUITY Utah 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 POPULATION Why 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
CRITERIA FOR DETERMINING DISPARITIES • Hospital readmission rates • Percentage diagnosed with diabetes Criteria Weighted • Emergency Department usage Highly • Ambulance use for typical outpatient care • Number of adults with disabilities • Percentage with a behavioral health diagnosis • Percentage with opioid prescriptions • Percentage with substance use disorders • Children with parents on SelectHealth Medicaid Criteria Weighted • Number of children with disabilities Moderately • Number of WIC recipients • Average income and education level
SELECTING GEOGRAPHIES – HOT SPOTTING
ALLIANCE DEMONSTRATION MODEL Improve Organization Improve Organization of Services of Services Physical Systematically Assess and Health Address Social Needs Collaborate with Local Partners Refer and Navigate to Community Partners Behavioral Health Align, Integrate, and Support Community Partners Leverage Digital Health Social Local Steering Committees Determinants and Analytics to Generate “Collective Impact” Engage Members Evaluate and Scale to Other Innovative Payment Communities Models
TACO NOT THIS THIS 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 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.
Q & A
Questions About the ACLC? If you have questions about the ACLC please email members@accountablecarelc.org
UPCOMING MEMBER EVENTS Workgroup meetings – 3 rd Tuesday of the month (June 19 th ) SAVE THE DATE – ACLC MEMBER MEETING October 23 rd - 24 th in Washington, D.C.
801.538.5082 | info@accountablecareLC.org | 4001 South 700 East suite 700, Salt Lake City, UT 84107
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