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Massachusetts Delivery Model Advisory Committee. October 4, 2012. Agenda. Section 1 . Introduction. The Project.
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Massachusetts Delivery Model Advisory Committee October 4, 2012
Section 1 Introduction
The Project The Medicaid Delivery Model Advisory Committee (Committee) was established under Section 178 of Chapter 131 of the Acts of 2010 to study comparative costs and benefits of varied care delivery models for the Medicaid program. Navigant Consulting contracted with the state of Massachusetts to assist in the efforts of the Committee. Navigant is conducting delivery system research and analysis in the context of MassHealth innovations and the rapidly changing Medicaid environment, as MassHealth develops new service delivery and payment models.
MASShealth: changing Environment Massachusetts has long been a leader in health care reform and Medicaid innovation, and is currently undergoing a period of rapid change: • Massachusetts payers and providers are among the most forward-thinkingin the country, with robust participation in innovative payment and delivery system models • Chapter 224 promotes adoption of alternative payment methodologies, including establishing a certification process for Model ACOs • MassHealth is developing alternative payment methodologies for MCO and PCC programs • Extension of MassHealth’s 1115 demonstration allows for Delivery System Transformation Initiatives whereby hospitals will receive incentive payments for system quality improvements
Project Scope • Identify individuals or organizations with expertise in Medicaid delivery of care models, managed care, accountable care organizations, chronic disease management, and patient centered medical homes. Some of these individuals will be invited to present their research to the Advisory Committee. • Model the fiscal impact to the Commonwealth for different delivery of care models, taking into consideration cost drivers and trends, utilization, case mix, and potential for adverse selection. This analysis should consider the impact of National Health Care Reform implementation. • Conduct research on Medicaid delivery of care models, including lessons learned from innovation in the MCO and PCC plans in Massachusetts and implications for the future. • Analyze the experience of other entities and states in initiating and implementing innovative care delivery models. Review and presentation of additional information related to these experiences will be highlighted for the Advisory Committee (this includes state surveys). • Describe the strengths and weaknesses of the MCO and PCC models to inform the state’s vision for health care payment and delivery moving forward, including the impact on patients and providers and long-term sustainability.
Project Scope • Describe the resources that would be needed to support the desired care delivery system(s), including information technology/data needs, practice supports and financing. • Coordinate and lead meetings with various stakeholder groups. • Prepare all agendas, reports, and/or presentations for Advisory Committee meetings. Draft the Advisory Committee’s report of findings and recommendations, including development of an implementation strategy. • Attend all Advisory Committee meetings and facilitate any sessions, as requested. • Take notes at all Advisory Committee meetings and synthesize data and recommendations gathered in the course of the meetings.
Section 2 Suggested Experts to Address Committee
Section 3 Payment and Delivery System Models and Features Payment and Delivery Models Program Features Common Service Carve-Ins/Carve-Outs Common Population Carve-Ins/Carve-Outs
Payment and Delivery Models and Features • States have long used several delivery and payment systems to provide services to their Medicaid populations: Risk based managed care, primary care case management and fee-for-service. • Emerging models include patient-centered medical homes and accountable care organizations. • Within these models there are multiple variations of program design features. • States must make also decisions about which services will be provided and which populations will be served by which delivery systems - “carve-ins” and “carve-outs”.
Common population carve-ins/carve-outsAged, Blind and disabled populations
Section 4 Summary
Summary • Delivery models and program features can be combined and tailored to address specific population nuances, account for historical trends and mesh with the current landscape. • Promising models incorporate elements of accountability and care coordination, high quality performance measures and patient centeredness. • The appropriate mix of these components for Massachusetts requires further analysis and assessment.
