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Medicaid Centennial Support: Identifying Service Improvements For

Medicaid Centennial Support: Identifying Service Improvements For Cost Savings and Health Improvement. Separating the Health and Care Systems. Bad Idea. 5% of People = 50% of Costs 20% of People = 80% of Costs 70% of Health Problems Stress related Mental Health System – Needs Work

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Medicaid Centennial Support: Identifying Service Improvements For

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  1. Medicaid Centennial Support: Identifying Service Improvements For Cost Savings and Health Improvement

  2. Separating the Health and Care Systems Bad Idea

  3. 5% of People = 50% of Costs • 20% of People = 80% of Costs • 70% of Health Problems Stress related • Mental Health System – Needs Work • Traditional Medical Models of Care Not Broadly Effective in Reducing Costs or Improving Health • Conflicting Incentives • Community Integrated Comprehensive Primary Care • Best Option for Reducing Cost and Improving Health • Need Effective PC Support Models across Broad Spectrum of Health • Need Additional PC Providers to Lower HC Cost Context for Program Development

  4. Assess why people leave town for care • Options: • By the equipment and develop the services to stop money from leaving town • Try to recruit the health professionals to staff • Lots of Financial Incentives • Manage patients better locally at the primary care and non-clinical levels • Build a comprehensive Primary Care Systems • Few Financial Incentives Stopping the Bleed Perspectives

  5. V E R T I C A L C O O R D I N A T I O N • Management • Diagnosis • Prevention • Treatment The Flow of Health Systems and Cost Pyramid Horizontal Integration of Systems

  6. Range of Care • Prevention • Diagnosis • Treatment • Management • Vertical Systems • Therapeutic Care • Subspecialty • In/Outpatient Hospital • Long Term Care • People • In the • Middle • Primary Care Providers • Medical • Dental • Behavioral • Family Support • Horizontal Services • Health Equity • Income / Poverty • Education • Social Services 4 Core Services Model

  7. Non-Clinical Patient and Community Support in PC Setting POPULATION FOCUS INDIVIDUAL / FAMILY SUPPORT AND EDUCATION INTENSIVE INTERVENTION Public Health/ Outreach Workers P R O M O T O R ES Care Coordinators Cost Cost % Population

  8. How this Translates into Practice Payment Structure Assumptions and Fiscal Impact Simple Math Perpective

  9. High Cost Medicaid Patient Managed with CHWs • Significant Pharmacy, ER and Inpatient Cost Savings - $1 saved for every $4 spent • Community PC Integrated Approach • Resources Build Local PC Infrastructure • Contracting to Expand Model to 9 States • Curriculum Development • Blue Cross / Blue Shield Added • HMS ORHP Grant provides Care Coordination to the Uninsured “For all measures, there was a significant reduction in both numbers of claims and payments after the community health worker intervention.” - JCH Care Coordination UNM/HMS/Molina Model Development

  10. Potential Impact of CC Services Broad Assumptions = 5% of Patients Equal 50% of Costs Provider Payment $300 pmpm

  11. HMS – CDC Funding Since 2000 • Developing Chronic Disease Prevention and Management Model • Patient / Family Support Programs • Diabetes Focus • NIH Hypertension Later • DOH Curriculum Development • Significant Improvements • Curriculum Development • “Findings suggest that patients with diabetes who participated in the LA VIDA program significantly increased the number of days they checked their feet and took their diabetes medications and significantly lowered their (HbA1c) levels” Journal of Family and Community Health Community Health Workers (Promotores) Diagnosis/Treatment and Support

  12. Preventing Disease Progression Patient Education, Clinical Preventive Services Protocols, Social Support

  13. REACH Model – Evidence Based • National REACH Coalition • Community Transformation Grant • NH, AL, MS, MI, MN, AZ, WA, SC • HMS REACH Grant • TX, NM, AZ, WA, OR, ID • 4 Partners /15 Communities • $3 million per year/five years Public Health/ Outreach Workers CHI – Developing the Evidence Community Development: Policy, Systems and Environmental Change Supporting Improved Health in Racial and Ethnic Populations

  14. Co-Investing in Health Contracted Plans for Local Health Improvement – Outcomes Driven

  15. Impact Summary

  16. Basic Proposal

  17. 2 Phase Contract with UNM Office of Community Health – HMS-CHI • Phase 1 • Model Articulation – with MAD • Developmental Work with MCOs • FQHC / Community Provider Readiness Assessments • Demonstration Program • Phase II • Cost / Price Assessment Analysis • Actuarial • Secondary Research • Phase-In Strategy • Capacity Building - MCOs • Training and Program Support - Providers

  18. Expanding Our Evidence Base Building Community Health 2012

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