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2009 ACAP CEO Summit

2009 ACAP CEO Summit. Controlling Long Term Care Costs and Improving Quality: The Role of Medicaid Managed Care Hank Osowski Senior Vice President SCAN Group July 15, 2009. 2009 ACAP CEO Summit. Controlling Long Term Care Costs and Improving Quality: It’s not your mother’s Medicaid!

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2009 ACAP CEO Summit

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  1. 2009 ACAP CEO Summit Controlling Long Term Care Costs and Improving Quality: The Role of Medicaid Managed Care Hank Osowski Senior Vice President SCAN Group July 15, 2009

  2. 2009 ACAP CEO Summit Controlling Long Term Care Costs and Improving Quality: It’s not your mother’s Medicaid! Hank Osowski Senior Vice President SCAN Group July 15, 2009

  3. Overview • Why Long Term Care Integration is critical • SCAN’s experience in California and Arizona • Opportunities to meet the challenges

  4. Why Long Term Care Integration • State and Federal spending on long term care projected at $3.7 trillion over the next twenty years* • Currently fifteen states spend $1 billion or more on long term care; by 2027 twenty-five states will exceed $1 billion in long term care expenditures* * State Medicaid Expenditures for Long Term Care, Shostak and London, September 2008: Congressional Budget Office estimate

  5. 2008 New York - $10.0b California - $5.6b Pennsylvania - $3.5b Ohio - $2.4b Texas - $2.3b New Jersey $2.1b Florida - $1.9b Illinois - $1.8b Massachusetts - $1.6b Minnesota - $1.6b 2027 California - $19.4b New York - $17.9b Pennsylvania $7.3b Ohio - $5.4b Florida - $5.2b New Jersey - $4.4b Minnesota - $4.1b North Carolina - $2.8b Illinois - $2.8b Washington - $2.6b Top Ten States in LTC Expenditures

  6. Why Long Term Care Integration • Elderly (10%) and Disabled (14%) represent a quarter of the Medicaid beneficiaries, yet consume 70% of Medicaid expenditures • Long term care, including home and community based services (HCBS), and acute care services each represent about half of those costs

  7. California 109,000 members 6,983 Medi-Cal Dual Eligibles (52% Aged, 40% Long Term Care) 21,000 NHC members Average age is 78 Arizona 2,700 unique members 2,500 ALTCS (49% are dually enrolled with SCAN) Average age is 75 SCAN Profile

  8. California Experience • Twenty-five years as a Social HMO (intense care coordination model); goal was to maximize members’ independence • Provided acute and HCBS services to about 26,000 Medicare beneficiaries • CMS discontinued demonstration program December 2007 • SCAN only Social HMO to continue benefits to members at a cost of about $30 million per year

  9. California Experience • Contract with state since 1985 to provide secondary acute care and HCBS services to Dual Eligible beneficiaries • 2008 contract expanded to also include custodial care • Currently have 6,983 Dual Eligible members; two thirds are long term care • Care coordination now mostly telephonic, supplemented with specialty case management for complex cases

  10. California Experience • USC Andrus Gerontology Center researchers compared likelihood of transition to the community between SCAN members and Medicare FFS beneficiaries • SCAN members spent fewer days in a facility on average (127 vs. 270 days) • Significantly fewer SCAN members had stays lasting more than a year (11% vs. 23%) • Being a SCAN member increased the odds of transitioning out of the facility by 150%

  11. Geriatric Health Management

  12. Geriatric Health Management

  13. Arizona Experience • Awarded ALTCS contract October 2006; began operations with 164 members • Parallel development of MAPD Dual Eligible SNP (2007) and MAPD (2008) to coordinate care • Currently over 2,500 ALTCS and 1,500 MA members • Projected 2009 revenue over $200 million

  14. ALTCS Integration Model • Program encompasses full integration of acute care services, HCBS services and custodial care • Membership divided among skilled nursing facilities (27%), alternative residential (40%) and home and community settings (33%) • Membership ranges from seven years to mid-nineties • 62% receive some form of behavioral health • HCC Risk Score of MAPD SNP members is 2.012

  15. ALTCS Integration Model • Case Management is program cornerstone • Began with 14 staff (director, supervisor, ten case managers, a behavioral health coordinator, and an intake coordinator) • Case Management staff now at 62 (fifty case managers) and growing • Effectively a remote workforce • Key forms and assessments are automated • Access to all member information in SCAN systems • Shared responsibility for 24/7 coverage

  16. Opportunities Abound • Current disconnected care model is not sustainable • More states seeking solutions to meet long term care challenges and reduce impact on budgets; policy and model development leadership • Some federal health reform proposals include additional flexibility and funding for Medicare and Medicaid long term care integration

  17. Questions ??

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