New Opportunities for Payment Reform - Minnesota

1. New Opportunities for Payment Reform - Minnesota Ross Owen NASHP Annual State Health Policy Conference October 5, 2011

2. Goals for the Session • Provide a quick description of delivery system and payment reforms in Minnesota involving Medicaid • Place them in the context of the Affordable Care Act (ACA) • Prompt good questions that we can discuss here or after the session Ross

3. Primary Care Reform is Health Reform • Health Care Home Initiative • Multi-payer Design and Momentum pre-ACA • Medicare Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration • Sec. 2703 • Primary Care Provider Rate Increases Ross

4. Toward Accountable Care • Medicaid ACO Pilots (Health Care Delivery Systems [HCDS] Demonstration) • Early Lessons Learned • Defining “Total Cost of Care” is Different in Medicaid • Technical and Data Expertise Required • Path to Federal Authority is Uncertain • Varying Provider Appetites for Medicaid Risk Ross

5. Model 1: Virtual HCDS • Primary care organizations not affiliated with a hospital or integrated system (or any HCDS serving 1,000-2,000 attributed enrollees) Savings achieved beyond the minimum threshold are shared between the payer and delivery system 50/50 Ross

6. Model 2: Integrated HCDS • Integrated delivery systems providing a broad spectrum of care as a common entity Delivery system pays back a pre-negotiated portion of spending above the minimum threshold Savings achieved beyond the minimum threshold are shared between the payer and delivery system at pre-negotiated levels Ross

7. Strategies for Dual-Eligibles • Integrated Care for Dual-Eligibles Planning Demonstration • Policy and Data Work to Ensure that these Reforms Work for Duals as Well • Solidifying Managed Care Financing Mechanisms Already Serving Duals in Integrated Special Needs Plans (SNPs) Ross

8. Thank you! Ross