Texas Managed Long Term Services and Supports. National Health Policy Forum Presentation

Transcription

1 Texas Managed Long Term Services and Supports National Health Policy Forum Presentation Pam Coleman Texas Health and Human Services Commission April 25,

2 STAR+PLUS Model Risk-based, capitated managed care Integrates Medicaid funding and service delivery of long term and acute care Serves the elderly and disabled Began in Harris County (Houston) in 1998 Expanded in 2007 to 4 sites Over 153,000 enrolled 2

3 Access to Services: Results Increased use of preventative and support services (32% increase in attendant care, 38% increase in adult day care) Decreased use of acute medical services (28% decrease in hospital admissions) Decrease in Emergency Room Visits Members rate their HMOs high on providing needed services, equipment, and assistance (8.2 on 10 point scale) ix 3 Source Institute for Child Health Policy, 2003

4 Quality: Results External review completed July 2003 Chronically ill STAR+PLUS members were compared to equally ill people in a non-capitated primary care case management program Significant cost difference ($3,226 mo in STAR+PLUS vs. $13,160 mo in comparison group) Significant reduction in inpatient and ER use, especially in HMO with larger number of care coordinators Source: Institute I for Child Health Policy, November 2003 ix 4

5 STAR+PLUS Program Overall Expenditures Average Charges per Month All Healthy Significant Acute Minor Chronic Dominant/Moderate Chronic Malignancies & Chatastrophic STAR+PLUS Experiment Group STAR Control Group 5

6 Challenges for Implementation Consumers Perspective Perception of evil gatekeeper HMOs Concern with HMO s s lack of experience with LTSS Concern that the medical model with be emphasized over support and community service needs Concern that high need consumers will be directed to NFs Concern that gains in CDS will be lost 6

7 Challenges for Implementation LTSS Providers Many unsophisticated providers Requires significant education for both providers and the health plan Health plan claims payment systems will need to be adapted Health plan must have provider outreach capacity 7

8 New Non-capitated Integrated LTSS Model Implemented the Integrated Care Management (ICM) model in Dallas/Ft. Worth area in February 2008 State contracts with a single administrative service organization (ASO) to coordinate, authorize and manage acute and LTSS. Approximately 70k SSI members are enrolled. 8

9 STAR+PLUS Service Area Map Dallam Sherman Hansford Ochiltree Lipscomb Hartley Moore Hutchinson Roberts Hemphill STAR+PLUS Service Areas with HHS Regions (in red) Oldham Deaf Smith Potter 1 Randall Carson Gray Wheeler Armstrong Donley Collingsworth Parmer Castro Swisher Briscoe Hall Childress Hardeman Bailey Lamb Hale Floyd Motley Cottle Foard Wilbarger Wichita El Paso Core Service Area (CSA) Hudspeth Culberson Jeff Davis 10 Presidio Reeves Ward Brewster Cochran Yoakum Gaines Andrews Loving Winkler Ector Midland Pecos Hockley Crane Terry Martin Upton Terrell Lubbock Lynn Dawson Howard Glasscock Reagan Crosby Garza Borden 9 Crockett Mitchell Sterling Irion Val Verde Dickens Kent Scurry Bexar CSA Nolan Coke Tom Green Schleicher Sutton King Stonewall Fisher Edwards Kinney Maverick Jones Taylor Runnels Knox HaskellThrockmorton Concho Menard Kimble Real Uvalde Zavala Dimmit 2 Callahan Coleman Baylor McCulloch Mason Kerr Bandera Webb Frio La Salle Zapata Eastland Brown Gillespie Archer Young Shackelford Stephens Medina 8 Llano Kendall Jim Hogg Starr Mills San Saba Blanco Bexar Atascosa Duval Clay Palo Pinto Jack Erath Lampasas Burnet Comal Wilson McMullen Live Oak Jim Wells Brooks Hays Hidalgo Montague Parker Hood Comanche Bosque Hamilton 11 Coryell Travis Guadalupe Somervell Karnes Wise Bee Gonzales San Patricio Nueces Kleberg Kenedy Bell Williamson Caldwell Willacy Bastrop De Witt Goliad Cameron Cooke Tarrant Johnson Denton Hill McLennan San Augustine Falls Leon Houston Sabine Angelina Trinity Robertson 7 Madison Jasper 5 Milam Polk Newton Walker Tyler Brazos Grimes San Jacinto Burleson Refugio 3 Lee Fayette Lavaca Victoria Aransas Grayson Dallas Ellis Collin Navarro Limestone Washington Jackson Calhoun Rockwall Colorado Kaufman Van Zandt Freestone Austin Fannin Hunt Wharton Henderson Waller Rains Fort Bend Matagorda Lamar Delta HopkinsFranklin Titus Morris Anderson Wood Smith Montgomery Harris Brazoria Red River 4 Nueces CSA Camp Upshur Gregg Rusk Cherokee Shelby Nacogdoches 6 Liberty Galveston Bowie Hardin Chambers Cass Marion Harrison Panola Jefferson Orange Travis CSA Harris CSA HHSC, Medicaid/CHIP Managed Care Operations May

10 Final Thoughts Integrated programs are challenging but offer many benefits to consumers and states HMOs must treat this as a dedicated line of business, not an add-on to other States must hire dedicated staff to manage these programs Massive, coordinated education required Include consumers in design and implementation 10