Congressional Budget Office November 2, 2017 Exploring the Growth - - PowerPoint PPT Presentation

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Congressional Budget Office November 2, 2017 Exploring the Growth - - PowerPoint PPT Presentation

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Congressional Budget Office November 2, 2017 Exploring the Growth of Medicaid Managed Care Association for Public Policy Analysis & Management Fall Research Conference Alice Burns, Ben Layton, Noelia Duchovny, and Lyle Nelson Health,

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Congressional Budget Office

Association for Public Policy Analysis & Management Fall Research Conference

November 2, 2017

Alice Burns, Ben Layton, Noelia Duchovny, and Lyle Nelson Health, Retirement, and Long-Term Analysis Division

The information in this presentation is preliminary and is being circulated to stimulate discussion and critical comment as developmental work for analysis for the Congress.

Exploring the Growth of Medicaid Managed Care

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CONGRESSIONAL BUDGET OFFICE

Medicaid is a federal–state program that provides health benefits to over 70 million low-income individuals and accounted for $348 billion of federal spending and $205 billion in state spending in fiscal year 2015.

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CONGRESSIONAL BUDGET OFFICE

States typically use two payment systems: fee-for-service (FFS) and Medicaid managed care (MMC). States may adopt MMC to:

  • Increase predictability of spending or
  • Improve coordination of care, which

may reduce costs or improve outcomes.

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CONGRESSIONAL BUDGET OFFICE

This project aims to improve our understanding of:

  • Whether MMC is “the predominant

delivery system in Medicaid” and

  • How and why MMC has grown over

time. The project will therefore inform expectations for future growth.

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CONGRESSIONAL BUDGET OFFICE

Key to understanding the growth in MMC is understanding the difference between the percentage of Medicaid enrollment in MMC and the percentage of Medicaid spending that is attributed to payments for MMC.

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CONGRESSIONAL BUDGET OFFICE

Percentage of Total Medicaid Enrollment and Spending Accounted for by MMC

0% 20% 40% 60% 80% 100% 1999 2001 2003 2005 2007 2009 2011 Enrollment Spending

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CONGRESSIONAL BUDGET OFFICE

A major challenge to understanding the growth of MMC is the variation in state programs and the lack of systematic data. We constructed and plan to disseminate a new dataset to support comparisons of states’ MMC programs.

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CONGRESSIONAL BUDGET OFFICE

Beneficiaries’ Enrollment in and Spending on Medicaid Managed Care

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CONGRESSIONAL BUDGET OFFICE

CBO used Medicaid Analytic eXtract data

  • n beneficiaries’ spending and enrollment

from 1999 to 2012 (the most recent period for which the data were available). Analyses included beneficiaries who were eligible for full Medicaid benefits.

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CONGRESSIONAL BUDGET OFFICE

Types of Managed Care Organizations (MCOs) Comprehensive MCOs

  • General Comprehensive
  • Long-Term Services
  • The Program of All-inclusive Care for the Elderly (PACE)

Noncomprehensive MCOs

  • Behavioral
  • Dental
  • Case Management
  • “Other”
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CONGRESSIONAL BUDGET OFFICE

Enrollment in Medicaid Payment Systems, 2012 Millions of Beneficiaries

6.3 11.8 10.2 6.5 15.0 6.3

1 Comprehensive MCO only Comprehensive MCO, multiple MCOs Comprehensive MCOs, multiple MCOs, and FFS 1 Comprehensive MCO and FFS Noncomprehensive MCO(s) and FFS FFS only

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CONGRESSIONAL BUDGET OFFICE

Average Monthly Spending on Payments for MMC and FFS, 2012

Payments for MMC Payments for FFS Medicaid $118 $526 $1,329 $321 $27 $439 $553 $1,329 Comprehensive MMC Noncomprehensive MMC FFS Only

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CONGRESSIONAL BUDGET OFFICE

1 2 1 3 2 8 2 3 8 22 3 2 12 31 6 7 Nonelderly Adults Children Elderly and Disabled Beneficiaries Dual-Eligible Beneficiaries

Enrollment by Medicaid Eligibility Group, 2012 Millions of Beneficiaries

Comprehensive MMC FFS Only Noncomprehensive MMC

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CONGRESSIONAL BUDGET OFFICE

Average Monthly Spending on Payments for MMC and FFS, 2012

$175 $117 $1,068 $1,169 $241 $125 $534 $233 $416 $242 $1,602 $1,402 Nonelderly Adults Children Elderly and Disabled Beneficiaries Dual-Eligible Beneficiaries Payments for MMC Payments for FFS Medicaid

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CONGRESSIONAL BUDGET OFFICE

Percentage of Total Medicaid Enrollment Accounted for by Comprehensive MMC and of Total Spending Accounted for by MMC

0% 25% 50% 75% 1999 2001 2003 2005 2007 2009 2011 Percentage Nonelderly Adults Enrollment Spending 0% 25% 50% 75% 1999 2001 2003 2005 2007 2009 2011 Percentage Children Enrollment Spending

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CONGRESSIONAL BUDGET OFFICE

Percentage of Total Medicaid Enrollment Accounted for by Comprehensive MMC and of Total Spending Accounted for by MMC

0% 25% 50% 75% 1999 2001 2003 2005 2007 2009 2011 Percentage Elderly and Disabled Enrollment Spending 0% 25% 50% 75% 1999 2001 2003 2005 2007 2009 2011 Percentage Dual-Eligible Enrollment Spending

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CONGRESSIONAL BUDGET OFFICE

Annual Per-Beneficiary FFS Medicaid Spending Among Nonelderly Adults and Children in Comprehensive MMC, 2012

$84 $81 $53 $49 $35 $34 Mental/ Substance Use Prescription Drugs Clinic/ Outpatient Nonemergency Dental Other Acute Care Inpatient Hospital Total Spending per Beneficiary $2,783 Payments for MMC $2,408 Payments on FFS Medicaid $374

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CONGRESSIONAL BUDGET OFFICE

Annual Per-Beneficiary FFS Medicaid Spending Among Elderly and Disabled and Dual-Eligible Beneficiaries in Comprehensive MMC, 2012

$1,002 $450 $440 $429 $385 $261 Home/ Community Services Mental/ Substance Use Other Acute Care Prescription Drugs Institutional Care Inpatient Hospital Total Spending per Beneficiary $14,912 Payments for MMC $11,509 Payments on FFS Medicaid $3,403

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CONGRESSIONAL BUDGET OFFICE

Changes in States’ MMC Programs Between 1999 and 2014

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CONGRESSIONAL BUDGET OFFICE

Difference in Percentage of Spending Attributed to Payments for MMC

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CONGRESSIONAL BUDGET OFFICE

Number of States With Any Type of MMC by Program Type

45 1 41 29 2

General Comprehensive PACE Long-Term Services

16 2 4 27 8 16 7 12 21 7

Behavioral Dental Transportation Case Management Other

Comprehensive Noncomprehensive 1999 2014

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CONGRESSIONAL BUDGET OFFICE

Of States With General Comprehensive MMC, Percentage With Programs That Were Statewide or Regional

47% 62% 83% 32% Statewide Programs Regional Programs 1999 2014

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CONGRESSIONAL BUDGET OFFICE

Of States With General Comprehensive MMC, Percentage That Mandated Enrollment by Eligibility Group

76% 73% 44% 18% 93% 88% 76% 41% Nonelderly Adults Children Elderly and Disabled Beneficiaries Dual-Eligible Beneficiaries 1999 2014

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CONGRESSIONAL BUDGET OFFICE

Of States With General Comprehensive MMC, Percentage That Covered Various Types of Services

100% 98% 73% 71% 76% 58% 11% 4% 95% 90% 78% 78% 68% 66%

Hospital and Acute Care Postacute care Prescription Drugs Mental/Substance Use Nonemergency Transportation Nonemergency Dental Institutional Care Home/Community Services

1999 2014

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CONGRESSIONAL BUDGET OFFICE

Key Takeaways

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CONGRESSIONAL BUDGET OFFICE

By integrating quantitative and qualitative data, CBO developed a more in-depth perspective on the growth of MMC and created a dataset to support future empirical research.

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CONGRESSIONAL BUDGET OFFICE

Measurement matters:

  • MMC growth may be defined in terms
  • f spending or enrollment.
  • Comprehensive MMC has different

levels of comprehensiveness. Such considerations have significant implications for developing policy analysis and expectations for future growth.