Investing in Quality: Medicaid Opportunities

1. Investing in Quality: Medicaid Opportunities Oklahoma Health Care Authority Board Retreat August 27, 2009 Melanie Bella Senior Vice President Center for Health Care Strategies

2. CHCS Mission To improve health care quality for low-income children and adults, people with chronic illnesses and disabilities, frail elders, and racially and ethnically diverse populations experiencing disparities in care. Our Priorities Improving Quality and Reducing Racial and Ethnic Disparities Integrating Care for People with Complex and Special Needs Building Medicaid Leadership and Capacity 2

3. THECOMMONWEALTHFUND CHCS Funding Partners • Aetna Foundation • Agency for Healthcare Research and Quality • The Annie E. Casey Foundation • California HealthCare Foundation • Colorado Health Foundation • The Commonwealth Fund • Kaiser Permanente • New York State Health Foundation • Robert Wood Johnson Foundation

4. Medicaid’s Fast Facts 4 4

5. Medicaid’s Role for Selected Populations Percent with Medicaid Coverage: Families Aged & Disabled Note: “Poor” is defined as living below the federal poverty level, which was $17,600 for a family of 3 in 2008. SOURCE: KCMU, KFF, and Urban Institute estimates; Birth data: NGA, MCH Update.

6. CHCS: Accelerating Innovation in Medicaid Integrated System Fragmented Care • Multiple providers • No coordination • Lack of patient focus • Inadequate information sharing • No accountability • Unaligned payment • Accountable medical home • Coordinated care for patients with complex needs • Patient-centered care • Information exchange • Performance measures • Incentives/aligned financing

7. FINANCING OPTIONS Primary Care Case Management, Administrative Service Organizations, etc. Alternative Models Care Management Approaches Disease Management; Chronic Care Management; Medical Home Ways States are Coordinating Care for Beneficiaries with Complex Needs Fee for Service Full-Risk Managed Care

8. OklahomaMedicaid’s “Learning Laboratories” Reducing Disparities at the Practice Site • Target small provider practices (10) with high volume of minority patients for practice-site quality improvement • Stakeholder team includes Oklahoma Health Care Authority, Iowa Foundation for Medical Care, and APS Health Systems Medicaid Leadership Institute • 12-month executive training focused on policy, technical, and leadership skills • Position directors to maximize Medicaid’s contribution to national health system transformation • Lynn Mitchell, MD, is in the inaugural class Return on Investment Purchasing Institute • Build state capacity to forecast the financial returns that may be generated by investments in quality improvement • OK Medicaid used projected savings for people with diabetes in the Health Management Program (HMP) to gain stakeholder support • Currently calculating ROI for emergency room utilization program Care Management for Complex Populations • Early innovator in development of HMP for high-need, high-cost beneficiaries

9. Reform Status: House Tri-Committee Bill – Passed by all 3 Committees Expands Medicaid to 133% FPL for all Americans Individual and Employer Mandates Insurance Exchange with Public Plan Option Blue-Dog Amendments States Pay for 10% of Medicaid Expansion Beginning in 2015 Center for Medicare and Medicaid Payment Innovation 9

10. Reform Status: House Leadership Crafting Bill for House Floor Delicate Balancing Act between Blue Dogs and Progressive Democrats CBO Score Plays Vital Role Town Hall Impact 10

11. Reform Status: Senate Health Education Labor and Pensions (HELP) Committee Bill – Passed out of Committee Expands Medicaid to 150% FPL for all Americans Individual and Employer Mandates Insurance Exchange with Public Plan Option Finance Committee – No Bill, Only Policy Options Gang of Six Negotiations – Deadline September 15 Exchange with Cooperatives Unknowns - Medicaid Expansion % of FPL, and State Share of Financing 11

12. Reform Status: Timeline • September • House Floor Vote • Senate Finance Committee Markup • October • Senate Floor Vote • Conference Committee • To Be Determined • House and Senate Votes on Conference Committee Compromise

13. Reform Status: Wild Cards • Public Opinion • “Government-Run” Health Care • End-of-Life Provisions • Continuing Industry Support • PhRMA Deal • AMA, AHA, AHIP, etc. • Budget Reconciliation

14. Reform Considerations for Oklahoma • Medicaid Expansion • How Many Beneficiaries? • How Quickly? • Who’s Paying? • Movement into Exchange? • Potential Impact on Insure Oklahoma • Medicaid (and Medicare) Financing Reform • State Role in Exchange, Public Plan or Cooperatives

15. Visit CHCS.org to… • Downloadpractical resources to improve the quality and efficiency of Medicaid services. • Subscribeto CHCS eMail Updates to find out about new CHCS programs and resources. • Learnabout cutting-edge state/health plan efforts to improve care for Medicaid’s highest-risk, highest-cost members. www.chcs.org