Californias Health Care Coverage California s Health Care Coverage - - PowerPoint PPT Presentation

California’s Health Care Coverage California s Health Care Coverage Initiative:

County Successes and a Look Ahead to Health Reform to Health Reform

Caroline Davis, Senior Consultant

April 14, 2010

d i @h lth t cdavis@healthmanagement.com

Overview of HMA’s HCCI Work Overview of HMA s HCCI Work

• Funded by TCE and CHCF to work with HCCI
• ver last 2 years:
• Provided technical assistance to HCCI

counties C d t d lit ti t f l

• Conducted qualitative assessment of lessons

learned and identified consideration for future extension or expansion extension or expansion

• Co-leading Medi-Cal HCCI Technical Work

Group as part of waiver renewal

1

Group as part of waiver renewal

Technical Assistance Project

2

Technical Assistance Project Technical Assistance Project

• Worked with 10 HCCI counties on financial
• Worked with 10 HCCI counties on financial

sustainability and redesign of indigent delivery systems y

• Convened two-day Leadership Summit in

January 2009 y

• Provided county-specific TA to three counties:
• Orange: focused on specialty referrals and

g p y network development

• San Diego, San Mateo: focused on financial

3

g sustainability

County-Specific TA Overview County Specific TA Overview

• Counties operate different HCCI programs
• Counties operate different HCCI programs,

delivery systems

• HMA teams reviewed current county

HMA teams reviewed current county

• perations, interviewed stakeholders
• Provided recommendations tailored to each

Provided recommendations tailored to each county’s interests

• Recommendations reinforce need to:
• Move away from “silos”
• Coordinate care

4

• Collaborate with stakeholders

HCCI Successes

5

HCCI is Unique HCCI is Unique

• HCCI is unprecedented and unique across the
• HCCI is unprecedented and unique across the

states

• All 10 counties have made remarkable strides

All 10 counties have made remarkable strides in 2-1/2 years

• Strong local commitment to system

Strong local commitment to system innovations and improvements

• HCCI focuses on issues critical to health

reform implementation and on-going success

• Offers lessons for Medi-Cal and national

6

health reform

HCCI Has Been A Success HCCI Has Been A Success

• HCCI has:
• HCCI has:
• Expanded coverage to medically-indigent adults
• Driven innovation

e

• at o
• Supported reform of local delivery systems
• MI adults enrolled in organized system of care

with:

• A medical home
• Defined benefits package

A t h i t i

7

• Access to chronic care management services

HCCI’s Promising Results HCCI s Promising Results

• Improvements in system efficacy:
• Improvements in system efficacy:
• Clinic operations
• Coordinated specialty referrals
• Coordinated specialty referrals
• Information exchange across providers
• Expanded network capacity (public-private)
• Key Outcome: Reform impact is significant

and goes beyond target population

8

Sustainability Has Been A Challenge

• State county fiscal crises have significant
• State, county fiscal crises have significant

implications

• Pressure to reduce spending

Pressure to reduce spending

• Number of MIAs increasing
• Significant pent-up demand for services, even

among enrollees known to county systems g y y

• Care management strategies are beneficial

but may be cost-effective only over time

9

HCCI Key Elements HCCI Key Elements

• Implementation of formal eligibility and
• Implementation of formal eligibility and

enrollment process considered crucial to continuity of care y

• Integration of care with emphasis on primary

and preventive services coordinated through p g the medical home

• Enhancement of capacity and operation of

local provider networks to assure access

• Use of health IT as foundation for system

10

redesign and successful operation

Looking Ahead to Looking Ahead to Health Reform

11

HCCI: Bridge to Health Reform? HCCI: Bridge to Health Reform?

• HCCI enrollees qualify for Medi-Cal expansion

HCCI enrollees qualify for Medi Cal expansion (to 133% FPL) or Exchange (133-200% FPL)

• Medicaid funding could begin April 2010

g g p

• CA could implement Medicaid funding via

HCCI in new waiver

• Automatically meets “budget neutrality”
• Spending limited by available local dollars

Spe d g ted by a a ab e oca do a s

• Could be structured to limit county risk
• Early adoption would help maximize federal

12

Early adoption would help maximize federal funding in 2014 (100% FMAP)

Health Reform: Key Policy Questions

• Should HCCI focus only on Medicaid expansion
• Should HCCI focus only on Medicaid expansion

population?

• Should HCCI expand to new counties? Within

p existing counties?

• How can HCCI, Medi-Cal, Exchange be

synchronized to allow easy transitions in 2014?

• How will Medi-Cal expansion be done in 2014?

CC S

• What happens to HCCI, Section 17000

requirement in 2014?

• How will access issues be addressed?

13

• How will access issues be addressed?

Final Thoughts Final Thoughts

• Counties have shown strong support to
• Counties have shown strong support to

continue HCCI

• Counties used HCCI to consolidate build on

Counties used HCCI to consolidate, build on earlier efforts to improve health system

• perations

p

• Organized system of care key to sustainability
• ver longer-term
• Counties well-positioned to help lead health

reform implementation in CA

14