Medicaid Health Plans of America Presented by Marsha Morris, Commissioner Bureau of Medical Services West Virginia Department of Health and Human

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1 Medicaid Health Plans of America Presented by Marsha Morris, Commissioner Bureau of Medical Services West Virginia Department of Health and Human Resources November 2, 2007

2 Mountain Health Choices The First Step Toward a New Medicaid West Virginia is taking steps to improve the health of Medicaid members. Mountain Health Choices (MHC) represents the first phase in West Virginia s effort to redesign Medicaid.

3 Medicaid Redesign Medicaid Redesign Implementation Plan PHASE I PHASE II PHASE III PHASE IV Children and Adults with Children (TANF Population) Pregnant Women Elderly All Other Populations

4 DEMOGRAPHICS West Virginia Beneficiaries By Expenditures WEST VIRGINIA MEDICAID BENEFICIARIES AND EXPENDITURES BY ENROLLMENT GROUP 100% 90% 80% 70% 8.33% 24.39% 21.00% Elderly (31,144) Blind & Disabled (91,190) Adults (60,233) Children (191,316) 60% 50% 16.11% 44.16% 40% 30% 20% 10% 0% 51.17% Beneficiaries 7.48% 27.36% Expenditures Note: Beneficiaries are enrollees who received a Medicaid service. Blind & Disabled includes adults, children, and elderly who qualify based on a disability.

5 Deficit Deficit Reduction Act of of Deficit Reduction Act of 2005 The DRA changes the face of Medicaid. Rx LTC Transfer of Assets Fraud and Abuse Benefits and Cost Sharing Financing Grants West Virginia is poised to move Medicaid to a model that emphasizes preventive care, partnership, personal empowerment and responsibility.

6 Improving Children s Health in West Virginia Cause Unhealthy Diet High Smoking Rate Lack of health education Effect 21% childhood obesity rate 12% of WV children have at some point been diagnosed with asthma Solution Care Management Preventative Health Care Health Education Healthy Rewards

7 Improving Parent s Healthy Adults Health in West Virginia State of Poor Health 10 % of WV adults have been told by physician that they have diabetes 285 in 100,000 WV adults have chronic heart disease 13% of WV adults have asthma WV adults rank 41 st in physical activity participation 64% of WV adults are obese, ranking next to last in the country Solutions Care Management Personal Responsibility Preventative Health

8 Mountain Goals of Health West Virginia Choices Medicaid Redesign An Overview Hallmarks for Members Prevention Personal Responsibility Establishment of a Medical Home Care Management Goals of MHC Establishment of a Medical Home Tailor benefits to needs of a specific population Coordinate care, especially for members with chronic conditions Provide members with the opportunity and incentives to maintain and improve their health

9 Mountain Health Choices Implementation Implementation Dates Implementation Dates 1. March 1, 2007: Began in three pilot counties 2. September 1, 2007: Phase 1 of Statewide expansion- 16 counties 3. October 1, 2007: Phase 2 of Statewide expansion- 21 counties 4. November 1, 2007: Phase 3 of Statewide Expansion- 9 counties * Six counties are currently in the process of contracting with HMOs

10 Basic Benefit Package Basic Coverage The Basic Plan covers all mandatory services and some optional services, but with limits including: Four prescriptions per month Five NEMT round trips per year Maximum of 25 home health visits annually

11 Enhanced Benefit Package Member Agreement Signature required for enrollment in Enhanced Plan Outlines responsibilities of members Encourages appropriate use of the health care system Signature required for enrollment in Enhanced Plan Health Improvement Plan Member and physician develop health plan for the next year Health Improvement Plan includes: preventive screenings immunizations laboratory tests number of well / sick visits health education classes Reflects EPSDT standards for children

12 Enhanced Enhanced Benefits Package Enhanced Education Classes Weight Management Programs Nutritional Education Diabetes Education Smoking Cessation Enhanced Health Care Coverage Cardiac Rehabilitation Services More non-emergency medical transportation No limits on the number of prescriptions Contact lenses for children Clinic and rehab services

13 Healthy Rewards Healthy Rewards Concept Guiding Principles Provide strong incentives to promote healthy behaviors and personal responsibility HRs should be simple for member to understand and access HRs should not impose additional work on providers

14 Advanced Medical Home Medicaid Transformation Grants Pharmacy Medicaid E Health

15 Advanced Medical Home MTG - Pharmacy Automated Prior-Authorization System POS Enhanced Coordination of Care System Clinical Web Portal

16 Advanced Medical Home MTG - Improved Medicaid Project Management Advanced Medical Homes Health Improvement Institute Healthy Reward Accounts Education and Outreach

17 WV HEALTH IMPROVEMENT INSTITUTE ADOPTION OF ELECTRONIC HEALTH RECORDS MEASUREMENT SELF MANAGEMENT SUPPORT EDUCATION OF THE PROVIDER COMMUNITY PAY FOR PERFORMANCE QUALITY COLLABORATIONS Develop proposed mechanisms to accelerate adoption of electronic health records in West Virginia Create a forum of alignment of measures across stakeholders to facilitate reporting To align and improve access to resources and best practices to improve the self-activation capacity of all patients To develop a system of provider engagement to accelerate Medicaid Transformation and assist physician practices with migration to AMH To provide guidance on the deployment of a P4P program as a model for the State To support a focused collaboration of key stakeholders on improving quality, building on past initiatives Member Education Healthy Rewards Advanced Medical Homes Advanced Medical Homes Pay 4 Performance Evidenced Based Medicine Health Information Systems Electronic Health Information Provider Technology Incentives OTHER RELEVANT INITIATIVES WV HIN WVMI - OTHERS

18 Electronic Health Records Advanced Medical Home A team approach to care utilizing advanced information systems (including a standardized electronic health record); redesigned, more functional offices, and a whole-person orientation that focuses on quality, safety and care provided in a community context.

19 Advanced Medical Home MTG e-health Electronic Medical Records Electronic Prescribing Provider Portals Benefit Management Care Coordination

20 Mountain Health Choices Additional Information

21 Contact Marsha Morris, Commissioner West Virginia Department of Health and Human Resources Bureau for Medical Services (304)