Massachusetts Delivery Model Advisory Committee

1. Massachusetts Delivery Model Advisory Committee June 20, 2013

2. Agenda

3. Section 1 Introduction

4. Introduction Today’s discussion corresponds to these tasks from Navigant’s scope of work: • Draft the Advisory Committee’s report of findings and recommendations

5. Introduction The Committee’s work has significantly advanced our understanding of the MCO and PCC models and the evolving needs of the MassHealth program. The report compiles and presents valuable information about Medicaid delivery of care models including: • Lessons learned from innovation in the MCO and PCC plans in Massachusetts and implications for the future. • The experience of other entities and states in initiating and implementing innovative care delivery models. • 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.

6. Introduction The report compiles and presents valuable information about Medicaid delivery of care models including (continued): • 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 • The resources that would be needed to support the desired care delivery system(s), including information technology/data needs, practice supports and financing • A data-driven discussion of the relative behavioral health capacities of the MCO and PCC programs. • Findings and recommendations

7. Section 2 Final Report Recommendations Background Quality Cost Access Data and Transparency Alternative Provider Payments

8. Recommendations background • Both the MCO and PCC models are well-established parts of the health care landscape in Massachusetts, and each has widely recognized positive features: • The Massachusetts MCOs are among the highest ranking Medicaid managed care plans in the country, based on ratings by the National Committee for Quality Assurance (NCQA). • The MCOs have diverse coverage models and provider payment policies. • The MCOs are making meaningful progress toward the use of alternative provider payment methods. • The PCC program has a proven track record of caring for complex populations of patients. • The PCC program has enhanced its contract with its behavioral health vendor to incorporate care coordination capabilities for all types of services. • The PCC program is also beginning to make meaningful progress toward the use of alternative provider payments methods.

9. Recommendations background • Many stakeholders see value in having both programs continue. • There are risks and uncertainties associated with significantly or totally supplanting one or the other. • High-level comparisons of the cost performance of the MCO and PCC programs by population group do not themselves provide a clear indication that there would be a financial benefit to MassHealth from transitioning fully from one care delivery model to another. • HEDIS scores demonstrate strong performance of both the MCO program and the PCC plan on both medical and behavioral health measures for their respective populations; however, they make no adjustment for the different populations served by the two models. • Both the PCC and MCO programs are undergoing dramatic changes to further enhance their care coordination resources, to promote medical homes and behavioral health integration, and to expand the use of alternative payment arrangements, further complicating the use of historical data that predates these changes to make recommendations about the future of the program.

10. Recommendations background The Committee itself will not serve as a vehicle for recommending changes in the current “mixed” PCC/MCC approach within MassHealth. Recommendations focus on five key issues:

11. Quality Findings Recommendations The Committee reviewed quality data pertaining to the PCC and MCO programs and recognizes that both programs score highly on quality measures. The Committee also reviewed reports developed by the Massachusetts Association of Health Plans and the Massachusetts Behavioral Health Partnership. • Limitations with IT resources hinder MassHealth’s ability to provide timely data needed to manage quality in both the MCO and PCC models. • There are limited mechanisms for coordinating or standardizing use of quality measures among MCO alternative payment methodology initiatives, or for reporting on best practices among providers and between MCO and PCC programs. • Alignment and coordination of quality measures will be important to reduce administrative burdens. • Robust quality measures across a number of domains will also be important to assessing the quality of care. • Additional quality initiatives and monitoring activities may need to be undertaken to increase quality outcomes as well as to reduce costs.

12. Cost AND ADEQUATE FUNDING Findings Recommendations The Committee has reviewed an analysis of per member costs in the PCC and MCO programs, including limitations of directly comparing costs between the programs. • The Committee finds that, within the identified limitations, the relative, risk-adjusted costs of the PCC and MCO programs vary by the population segment served. For some population segments, the PCC program has lower per member costs and for other population segments, the MCO program has lower per member costs. • However, there are analytic challenges that limit the ability to compare per member costs between the PCC and MCO programs at the level of service lines. • The Commonwealth should improve data collection and analysis in order to facilitate a true “apples to apples” comparison. • The Committee acknowledges the challenges in tracking cost and quality in the context of new delivery models and recommends that additional efforts be focused on developing methods for such measurement. • The Committee recommends that MassHealth work to assess the costs of administering these two programs to identify opportunities for efficiencies. • Even with improved efficiencies in the delivery of coverage and care, it is essential that MassHealth be adequately funded so that it can appropriately compensate its providers and contractors.

13. Access to Medical and Behavioral Health Care Findings Recommendations The Committee reviewed the topics of medical and behavioral health throughout the data collection process as well as during an ad hoc meeting to discuss the topic of access to behavioral health in further detail. • Access to medical care for MassHealth patients is enhanced by the fact that 80% of Massachusetts’ physicians accept MassHealth insurance, significantly greater than the national average of 69%. • Additional analytic work is needed to understand how HEDIS and other quality measures are impacted by the respective behavioral health contracting strategies and partners in each program, the availability of practitioners in each area served by each program, and by the distinct populations served by the two programs. • The Commonwealth should continue to explore objective and data-driven ways to better monitor and assess members’ access to behavioral health as well as to medical care in general in both programs • MassHealth may want to consider using additional survey toolsto better assess the quality of care members are receiving. • In assessing access to health care, particularly behavioral health care, the challenges of provider reimbursement levels should be considered.

14. Data and Transparency Findings Recommendations The Committee conducted interviews with MCOs, MBHP and MassHealth staff to assess current data capabilities and the data needs for facilitating improved outcomes and alternative payment methodologies. • Contractors are currently providing profiling reports to providers, although metrics and formats vary. In addition, some provide access to reports updated in real-time. • MassHealth is providing reporting to providers on patient characteristics, utilization and cost through PCMHI. MassHealth is also planning program-wide initiatives to provide enhanced reporting and profiling to providers (via PCPR). • Significant IT systems and staffing enhancements (for MassHealth, contractors and providers) may be needed to support enhanced data collection and reporting capabilities. • MCOs need to have access to more detailed and more frequent data from MassHealth to facilitate accurate reporting for each of the payment reforms. • Additional infrastructure and staffing is also needed to facilitate data reporting to behavioral health and physical health providers.

15. Alternative provider Payments (APMs) Findings Recommendations The Committee reviewed current efforts in Massachusetts and other states to adopt APMs to identify the potential of alternative payment structures to reduce costs while improving quality. • MassHealth is building program-wide capacity for alternative payment arrangements through its PCMH and PCPR initiatives in both the PCC and MCO programs. • MCOs have operationalized payer-specific alternative payment structures and continue to develop new contracts using APMs. • Neither the MCO model nor the PCC model is predominantly using APMs today, and both programs have more work to do to deliver fully patient-centered whole person care. • Successful expansion and implementation of APMs relies on access to the data required to support the analytics necessary to operate APMs. This will require significant investment in IT enhancements and data analytic capacity. • Educating consumers and providers about alternative payments is important to ensuring the trust and support of these constituencies, especially as MassHealth moves to expand APMs. • MassHealth should regularly evaluate its own programs to ensure that it is meeting expected benchmarks while improving quality, access and cost for the Medicaid program.

16. Final steps • Questions or Comments on Report • Acknowledgements • Vote to Approve the Report