Center for Health Care Strategies Johns Hopkins University School - - PowerPoint PPT Presentation

www.chcs.org

Johns Hopkins University School of Public Health November 7, 2013

Shannon McMahon, Director Michelle Soper, Senior Program Officer Center for Health Care Strategies

Center for Health Care Strategies

A non-profit health policy resource center dedicated to improving health care services for Americans receiving publicly financed care

► Priorities: (1) enhancing access to coverage and services; (2) improving

quality/delivery system reform; (3) integrating care for people with complex needs; and (4) building Medicaid leadership and capacity.

► Provides: technical assistance for stakeholders of publicly financed care,

including states, health plans, providers, and consumer groups; and informs federal and state policymakers regarding payment and delivery system improvement.

► Funding: philanthropy and the U.S. Department of Health and Human

Services.

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Select CHCS National Initiatives

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State Health Reform Assistance Network Charity Care Affinity Group State Innovation Model Resource Center* Aligning Forces for Quality Advancing Medicaid Accountable Care Organizations: A Learning Collaborative Complex Care Innovation Lab Integrated Care Resource Center – Dual Eligible Demonstrations* Medicaid Health Homes Program Design* Medicaid Leadership Institute California Department

• f Health Care

Services Academy

Enhancing Access to Coverage and Services Improving Quality/Delivery System Reform Integrating Care for People with Complex Needs Building Medicaid Leadership and Capacity

*Federally-funded initiatives

Examples of CHCS Projects

• Complex Care Innovation Lab – Convening national health care innovators

to explore ways to improve services for the highest-need, highest-cost individuals receiving publicly financed health care.

► REACH: 11 innovative organizations in 10 states and Washington, DC

• State Innovation Model – Working with states to design and/or test their

models for statewide care delivery and payment reform aligning with the Triple Aim of improved health, improved patient experience, and reduced costs.

► REACH: 25 states, ≈ 43 million beneficiaries

• Medicaid Leadership Institute – Enhancing the leadership capacity of

competitively selected Medicaid directors to help them transform their programs into national models for high-quality, cost-effective care.

► REACH: 22 states, 40 million beneficiaries; representing roughly 2/3 of the nation’s total Medicaid population.

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CHCS is leading national Medicaid efforts to:

► Improve access and coverage to Medicaid services particularly for vulnerable populations. ► Instill value-based purchasing principles and reward quality. ► Develop innovative care models for the highest-need, highest- cost patients with multiple chronic illnesses. ► Integrate Medicaid and Medicare services and financing for the dual eligibles. ► Leverage the program’s purchasing strength to help drive quality improvements across public and commercial payers.

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Why States?

• States can be a driving force because they

► Pay for a large percentage of health care and have a major

stake in reducing avoidable costs

► Have regulatory powers over providers and payers ► Administer/regulate public health and social services ► Can integrate state health information exchange

infrastructure

► Can convene multiple parties

Medicaid: Many Vital Roles in Our Health Care System

SOURCE: Kaiser Commission on Medicaid and the Uninsured, 2012.

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Support for Health Care System and Safety-Net

16% of national health spending; 40% of long- term care services

State Capacity for Health Coverage

Federal share ranges 50% to 83%; For FFY 2012 ranges from 50% to 74.2%

Long-Term Care Assistance

1.6 million institutional residents; 2.8 million community-based residents

Assistance to Medicare Beneficiaries

9.4 million aged and disabled — 20% of Medicare beneficiaries

Health Insurance Coverage

31 million children and 16 million adults in low-income families; 16 million elderly and persons with disabilities

MEDICAID

Medicaid Basics: Program Size & Expenditures

Note: This assumes all states expand Medicaid by 2020

SOURCE: Centers for Medicare & Medicaid Services, National Health Expenditure Projections 2010-2020, 2011. p.2 available at: https://www.cms.gov/Research-Statistics- Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/proj2010.pdf

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Medicaid ‘s Growing Role as a Powerful Purchaser

• With the Medicaid expansion, there are new powerful incentives for

Medicaid to become a smarter purchaser

► Federal and state budget pressures and imperatives ► Medicaid stakeholders frequently look to the Triple Aim as they

consider policy changes – health care that is delivered at the right time, in the right setting, achieving the right outcome

► National efforts to contain cost look toward multipayer strategies:

Medicare, Medicaid, private market coverage (e.g., State Innovation Models)

• Medicaid is a major driver of these imperatives and will continue to be

looked to as a place to deliver value through smarter purchasing strategies

Source: Centers for Medicare & Medicaid Services, National Health Expenditure Projections 2011-2021, 2012. p.2 available at: http://www.cms.gov/Research-Statistics- Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2011PDF.pdf.

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Medicaid’s Purchasing Power

Medicaid serves more than 60 million Americans – soon to be 80 million

41% newborns 33% children Many people with chronic illnesses and disabilities Many frail elderly Poor health care quality is an issue for all Americans; however, the gap is substantially greater for Medicaid beneficiaries

As the largest purchaser of health insurance, Medicaid can leverage its purchasing power to: Access performance data Identify and address gaps in quality

Medicaid Fast Facts

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67 million

People in the United States with Medicaid coverage.

$440 billion

State and federal Medicaid spending for FY 2012.

7 - 11 million

Additional Medicaid/CHIP beneficiaries after 2014, pending state decisions on Medicaid expansion.

41%

Births in the United States covered by Medicaid.

1 in 3

Children in the United States covered by Medicaid.

57%

Medicaid beneficiaries under 65 who are from diverse racial/ethnic groups.

5%

Medicaid beneficiaries, many with chronic illnesses and disabilities, accounting for 55% of total Medicaid spending.

49%

Medicaid beneficiaries with disabilities diagnosed with mental illness.

43%

Total long-term care costs in the United States financed by Medicaid.

39%

Percentage of Medicaid dollars spent on Medicare-Medicaid enrollees.

72%

Medicaid recipients who are enrolled in managed care.

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MEDICAID STATE OF PLAY: States Expanding Coverage to Adults <138% FPL

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As of October 22, 2013. Source: Advisory Board. “Beyond the pledges: Where the states stand on Medicaid.” http://www.advisory.com/Daily-Briefing/Resources/Primers/MedicaidMap#lightbox/2/