Vermont’s Dual Eligible project

1. Vermont’s Dual Eligible project National Academy for State Health Policy’s 23rd Annual State Health Policy Conference Brendan Hogan Vermont 10/5/10

2. Overview • Vermont Population Context • Global Commitment 1115 waiver • Choices for Care 1115 LTC waiver • Governor’s Blueprint for Health • Current project – VT as Medicare Plan 2

3. VT Population context • Total state population – estimated 600,000 • Total Medicare population – est. 98,000 • Total Medicaid & RX population – est. 150,000 • Total Dual Eligible population – est. 15,000 3

4. Global Commitment 1115 waiver • Vermont has a first in the nation Global Commitment 1115 Medicaid waiver • Waiver includes all Medicaid services except SCHIP and LTC • http://ovha.vermont.gov/administration/2008-global-commitment-to-health-documents 4

5. Choices for Care 1115 LTC waiver • Vermont has a first in the nation 1115 LTC waiver where VT allows a choice of nursing home or home and community based services for LTC Medicaid eligibles • http://www.ddas.vermont.gov/ddas-programs/programs-cfc/programs-cfc-default-page 5

6. Governor’s Blueprint for Health • Governor Douglas created the Blueprint for Health in Vermont and charged the Vermont Dept of Health to carry out this chronic care management initiative which now involves multi-payer funded pilots in several VT communities • http://healthvermont.gov/blueprint.aspx • Governor Douglas created the Blueprint for Health in Vermont and charged the Vermont Dept of Health to carry out this chronic care management initiative which now involves multi-payer funded pilots in several VT communities • http://healthvermont.gov/blueprint.aspx 6

7. Vermont is a Medicare plan • VT would work with CMS on authority to act as a Medicare plan • Medicaid authority would remain with our two 1115 waivers. Duals are in both 1115 waivers • Financial, data, legal and programmatic analyses are occurring right now for this effort 7

8. Vermont – data analysis • Vermont’s Agency of Human Services has contracted with JEN Associates to assist us with analysis of Medicare and Medicaid Claims data http://www.jen.com/ • Claims analysis will include aggregate PMPM analyses for entire population as well as 4 subgroups 8

9. Vermont data analysis - subgroups • Analysis of Medicare and Medicaid claims data will be for the following subgroups: • LTC Medicaid • CRT – Community Rehabilitation and Treatment program (Mental Health) • Developmental Services • All other Aged Blind and Disabled 9

10. Purpose of data analysis • Create aggregate PMPM for all dual eligibles as well as the 4 cohorts • Apply the HCC – Hierarchical Clinical Classification standards to the data to assist the state in the data analysis and subsequent negotiations with CMS • http://www3.cms.gov/HealthCareFinancingReview/downloads/04Summerpg119.pdf 10

11. Vermont is a Medicare plan • Model would include expanding upon current Blueprint multipayer effort in Vermont where existing case management systems for Medicaid would be directly linked to Blueprint Community Health teams • Better community based coordinated care, we believe, will save both Medicare and Medicaid money and be more effective 11

12. Vermont is a Medicare plan • Discuss with CMS: • State is at risk • All Duals are included • Passive enrollment with an opt out provision 12

13. Vermont is a Medicare Plan Discuss with CMS: • Current and previous discussions with providers and advocates in Vermont • Shared savings options • Health care reform offers opportunities for a model like this to work for both a state and CMS 13

14. Questions Brendan Hogan, MSA Acting Commissioner VT Dept. of Disabilities, Aging and Independent Living (802) 241-2401 brendan.hogan@ahs.state.vt.us 14