Medicaid Payment and Delivery System Reforms: Minnesota s Experience

Transcription

1 Medicaid Payment and Delivery System Reforms: Minnesota s Experience SCOTT LEITZ ASSISTANT COMMISSIONER MINNESOTA DEPARTMENT OF HUMAN SERVICES AUGUST 12, 2013

2 Some Minnesota Context Political context: Democratic Governor (Mark Dayton), both Senate and House D controlled Policy Context: High employer based coverage, low (but growing) uninsurance rate Medicaid largely delivered through MCOs History of expansion through MinnesotaCare, starting in 92 Parents and kids to 275% Adults to 200% Expanded Medicaid in advance of 2014 to <75% FPG childless adults, 3/2011

3 Some Minnesota Context, continued Policy Context, 2013 legislative session: Full Medicaid expansion to 138% FPG passed in 2013 MinnesotaCare maintained through Basic Health Plan funding 138% to 200% State-Based Exchange (Mnsure)

4 2008 health reform law: Focus in recent years Standardized and statewide clinic and hospital quality measures Multi-payer health care home initiative Transparent cost and quality measurement of providers Focus on building up primary care base, increasing data capacity, and standardization of measurement processes Goal: expand coverage through opportunities presented through ACA, but do so in a sustainable manner Focus on developing more direct provider relationships

5 Minnesota s Approach to Medicaid ACO development Define the what we seek, rather than the how Work in partnership with providers to develop process Give providers choice to participate; i.e. voluntary, not mandatory Provide multiple opportunities for innovation under a framework of several models Allow for local flexibility and innovation under a common framework of accountability to total cost and quality of care Recognize that incremental is ok, and in many cases, necessary

6 Two Examples 1. Minnesota Medicaid ACO model: Health Care Delivery Systems (HCDS) Demo 2. Hennepin Health: A Safety-Net ACO

7 Example 1: HCDS Demonstration Minnesota Medicaid ACO model: Health Care Delivery Systems (HCDS) Demonstration

8 Authorizing legislation for Minnesota s Medicaid ACO Demonstration: HCDS The Minnesota Department of Human Services shall develop and authorize a demonstration project to test alternative and innovative health care delivery systems, including accountable care organizations that provide services to a specified patient population for an agreedupon total cost of care or risk/gain sharing payment arrangement. (Minnesota Statutes, 256B.0755)

9 Minnesota s Medicaid Started with RFI process, leading to an RFP Remember, voluntary model Six providers, serving nearly 100,000 of our Medicaid enrollees, started in our HCDS model in January 2013 CY : First Demonstration Period

10 Minnesota s Medicaid ACO Demo (HCDS): Nearly 100,000 Enrollees HCDS Geographic area Size (# Attributed) CentraCare Central MN, north of Minneapolis/St. Paul 9,813 Children s Hospitals Minneapolis/St. Paul 14,854 Essentia Health Duluth/Northern MN 33,289 FQHC Urban Health Network (FUHN; 10 FQs) Minneapolis/St. Paul 21,382 North Memorial Minneapolis/St. Paul 4,426 Northwest Metro Alliance (Alllina Health/HealthPartners) Minneapolis/St. Paul 11,703

11 Key Design Elements Payment model agreements (under TCOC framework) These define level of gain/risk sharing Attribution methodology, populations served Quality measures to be included Built off statewide quality measures work (2008 reform law) Data feedback to providers Align with other efforts: Medicare, Commercial Role of MCOs

12 Model 1: Virtual HCDS Primary care organizations not affiliated with a hospital or integrated system (or any HCDS serving 1,000-2,000 attributed enrollees) Total Cost of Care: Risk-Adjusted Projection Total Cost of Care: Observed (Below Projection) Baseline Year 1 Year 2 Year 3 Payer and Delivery System share equally any savings achieved beyond the minimum threshold

13 Model 2: Integrated HCDS Integrated delivery systems providing a broad spectrum of care as a common entity Total Cost of Care: Risk-Adjusted Projection Total Cost of Care: Observed Above Projection) Total Cost of Care: Observed (Below Projection) Delivery system pays back a pre-negotiated portion of spending above the minimum threshold. Payer and Delivery System share at pre-negotiated levels savings achieved beyond the minimum threshold. Baseline Year 1 Year 2 Year 3

14 Example 2: Hennepin Health Hennepin Health: A Safety-Net ACO a Medicaid ACO focused on Minnesota s early Medicaid expansion population (<75% FPG) Population with co-existing mental health, CD/SA, and physical chronic health conditions an MCO-ACO that integrates medical, behavioral and social services for single adults expansion group who are high users of county services)

15 Hennepin Health: integration with social services and behavioral health Safety-net ACO Population focus: adults on Medicaid with incomes below 75% FPG Hennepin county receives capitation rate roughly equivalent to MCO cap rates Opportunity for savings outside the Medicaid program (i.e. corrections and social services Hennepin county: Minnesota s largest county (Minneapolis)

16 Observations We re using our SIM grant to continue to supplement and develop the data resources needed data won t solve every problem, but it ll kill any initiative. But we re focusing our efforts. Ask providers: they know a lot about who uses a ton of services and how best to serve them. Then give them the data. Partnerships with MCOs are positive and possible, but they need to be partnerships.

17 Our next steps RFP closed in June several new providers joining our Medicaid ACO Rolling RFP moving forward Focused RFP on pilots around acute/postacute/social service financial and delivery integration Continued work on risk adjustment, quality measures, alignment.

18 Contact Scott Leitz Assistant Commissioner Minnesota Department of Human Services St. Paul, MN Phone: (651)