Buffy L. Heater, MPH Director of Planning & Development Oklahoma Health Care Authority

1. COORDINATING CARE FOR MEMBERS DUALLY ELIGIBLE FOR MEDICARE AND SOONERCARE:EXPLORING A NEW FRONTIER Buffy L. Heater, MPH Director of Planning & Development Oklahoma Health Care Authority Heater 1

2. Oklahoma Dual Eligible Population 2 SoonerCare727,369 Medicare607,465 Duals104,538 Source: SoonerCare data as of June 2011 Heater 2

3. Dual Eligibles by Race Heater 3

4. Dual Eligible Population by Gender • 66,308 Females • 39,224 Males Heater 4

5. Dual Eligibles by Region Source: SoonerCare data as of June 2011 Heater 5

6. Dual Eligible Reimbursement by Quarter Source: OHCA Fast Facts March 2011 Heater 6

7. Per Member Per Month Cost (monthly average per quarter) Source: OHCA Fast Facts March 2011 Heater 7

8. Reasonable Conclusions • Services for the Duals are expensive as they require extensive care. • Care being rendered between two programs results in fragmented and uncoordinated care. • Care coordination would be a valuable added service. • Improved quality of care • Positive budget impact Heater 8

9. Original Proposal • OHCA envisioned establishing a state-operated benefit plan for duals, in lieu of Medicare • OHCA would have been responsible for ALL CARE of duals, demonstrating outcomes • Would have required CMS and OHCA to agree upon a cap rate for dual services • Savings shared between OHCA and CMS BUT… CMS financing models require 3-way contracts  Heater 9

10. Proposal #1 SoonerCare Silver Heater 10

11. OHCA Care Management • Why OHCA should be the solution: • The agency already applies care coordination to its SoonerCare members. • Adding Care Management to the Duals doesn’t overwhelm the SoonerCare program. • Spreading our fixed cost over a larger population should result in lower PMPM costs. (economies of scale) Heater 11

12. Modified Proposal • OHCA “sells” our proven and effective managed care services for the Dual population to CMS. • Enhance existing care coordination efforts • 7 Regional Nurse Care Management Teams • 1 Health Management Team • Intensive care management for top 5,000 utilizers • Covers wide range of diagnosis Heater 12

13. PACE - Interdisciplinary Care Team Heater 13

14. Proposal #3 - THIZ • University of Oklahoma – Tulsa • School of Community Medicine • Tulsa’s Health Innovation Zone (THIZ) • Create an ACO in Tulsa area serving high cost, dual eligible patients • Focused on providing payment models that promote improved patient outcomes and an overall lower cost of care. Heater 14

15. No time like the present… 15 • Data, data, data • Stakeholders • Develop the plan • Stakeholders • Finalize the plan • Stakeholders And did I mention…stakeholders? Heater 15

16. Oklahoma Resources • Oklahoma Medicaid Program Fast Facts • Opportunities for Living Life Document • http://www.okhca.org/research.aspx?id=87&parts=7447 • Evaluation of Oklahoma’s Medicaid Service Delivery System • Mathematica Evaluation of SoonerCare Choice • http://www.okhca.org/research.aspx?id=10087&parts=7447 • Annual, Performance, and Quality Reports; Strategic Plan • http://www.okhca.org/research.aspx?id=84&parts=7447 Heater 16

17. Contact Information Buffy Heater, MPH Director of Planning & Development, OHCA (405) 522-7545 Buffy.Heater@okhca.org Marva Williamson Project Manager, Dual Eligible Initiative, OHCA (405) 522-7319 Marva.Williamson@okhca.org Heater 17