Jon Courtney, PhD Program Evaluation Manager, Legislative Finance - - PowerPoint PPT Presentation

▶

Oct 15, 2023 130 likes •305 views

Jon Courtney, PhD Program Evaluation Manager, Legislative Finance Committee Presentation to the Legislative Health & Human Services Committee September 21, 2015 1 Various LFC staff contributed to this evaluation: Maria Griego, Program

SLIDE 1

Jon Courtney, PhD Program Evaluation Manager, Legislative Finance Committee Presentation to the Legislative Health & Human Services Committee September 21, 2015

SLIDE 2

 Various LFC staff contributed to this

evaluation:

Maria Griego, Program Evaluator Cody Cravens, Program Evaluator Pam Galbraith, Program Evaluator Jenny Felmley, PhD, Program Evaluator Shane Sharif, Intern

SLIDE 3

 LFC program evaluation looking at Centennial

Care Waiver and Managed Care.

 Three themes emerged in this evaluation.

Cos
st.
t. Cost containment initiatives are at risk and the

reliance of Medicaid on the general fund will increase significantly.

Care.
e. The amount and quality of utilization data has

deteriorated leaving the question of whether enrollees are receiving more or less care.

Cont

ntrol.

rol. Additional controls are needed to ensure that

rates are appropriately low and to better position the Legislature to take a more active role in the setting of financial priorities for Medicaid.

SLIDE 4

$2,493 $2,394 $2,381 $2.390 $3,712

$0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 CY10 CY11 CY12 CY13 CY14

New Mexico Managed Care Medicaid Total Capitation Payments By Program Area (in millions)

Behavioral Health Physical Health State Coverage Initiative Coordination of Long Term Services Behavioral Health Medicaid Expansion Physical Health Medicaid Expansion

Source: HSD Capitation Payments by Plan by Cohort Report Note: According to HSD, CY14 managed care payments includes costs associated with retro eligibility previously recorded as FFS expenditures that will be reconciled.

Medicaid Expansion=$973 Million

SLIDE 5

Managed care enrollment will approach 800K by FY18

The GF need for Medicaid will grow beyond $1 billion by FY18

 LFC estimates a

growing Medicaid budget for the foreseeable future due to:

Increased enrollment and
Phasing down of federal

matching funds between 2017 and 2020 for expansion.

100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 Jan-15 Mar-15 May-15 Jul-15 Sep-15 Nov-15 Jan-16 Mar-16 May-16 Jul-16 Sep-16 Nov-16 Jan-17 Mar-17 May-17

Estimated Medicaid Managed Care Enrollment

Source: HSD Aug 2015 Projection

SLIDE 6

In FY97, Medicaid accounted for about 6% of GF Appropriations In FY15, Medicaid accounted for about 15% of GF Appropriations

$849 $867 $891 $891 $912 $977 $1,076 $1,111 $1,164 $0 $200 $400 $600 $800 $1,000 $1,200 $1,400 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 FY20 Total General Fund (in millions)

Actual and Projected General Fund Impact From Medicaid FY12 to FY20 (in millions)

Source: LFC 2015 Post Session Review and HSD Medicaid Projection Note: FY12-FY14 are actuals, FY15 is operating budget

Projected

SLIDE 7

 Centennial Care was originally estimated to

bend the cost curve by up to 4% or $670 million over 5 years.

Subsequent estimates revised savings to a total of

$257 million.

 Implementation of cost savings components

have been problematic.

Waiver r Savings gs Initiati tives ves Total Projecte cted Savings ngs Impleme mentat ntatio ion n Status

Care Coordination $31 million 47% of enrollees reached in first year Health Homes $37 million Delayed 2 years and number of planned Health Homes cut in half ER Copay $3 million Not implemented Total $71 million

SLIDE 8

 Care Coordinators:

Assess health risks and

needs;

ID services and develop care

plans; and

Consult with member’s

providers and assist with access.

 HSD stated care

coordination would save $31 million over five years by providing efficient and appropriate care.

Client Refused 9% Not Yet Contacted by MCO 26% Unreachable 65%

Reasons for Incomplete Care Coordination Tasks

Source: MCO Q4 CY14 Care Coordination Reports

SLIDE 9

 Health homes are a key component of

Centennial Care-expected to reduce costs by $36.6 million.

 Originally health homes and payment reform

projects were performance metrics for contract incentives, but were later removed.

 The number of planned health homes was cut

from four to two and implementation delayed by at least two years.

SLIDE 10

 PMPM costs are projected to be higher in

FY16 compared to FY14 for all service areas except behavioral health.

 Managed care reporting includes fewer

utilization categories, and categories are not comparable across years.

 Utilization data that can be compared

indicates cause for concern for behavioral health.

SLIDE 11

$280 $265 $265 $278 $322 $248 $236 $231 $231 $277

$200 $220 $240 $260 $280 $300 $320 $340 2010 2011 2012 2013 2014

Physical Health Capitation Average PMPM and MCO Average PMPM Expenditures CY10-CY14

Capitation PMPM (Total HSD Capitation Payments/ Member Months) MCO Expenditure PMPM (Total MCO expenditures/ Member Months)

Source: LFC Analysis of HSD 30A and CC Financial Reports Note: Capitation reported by MCOs do not tie to the actual cap rates because of revenue accruals (expected to receive as well as amount expected to pay back to HSD).

SLIDE 12

Evidence-based treatment providing $3 to $1 ROI

According to HSD, CMS says CCSS is “medically necessary”

50 100 150 200 250 300 350 400 450 500 $0.00 $0.50 $1.00 $1.50 $2.00 $2.50 Unduplicated Clients Served Total Spent (in millions)

Multisystemic Therapy Spending and Clients Served Ages 0-18

Unique Members Served Total Spent

HSD Suspends Payment to 15 Providers

Source: OptumHealth CI-09, CC Report 41

500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 $0.00 $0.20 $0.40 $0.60 $0.80 $1.00 $1.20 $1.40 $1.60 $1.80 $2.00 Unduplicated Clients Served Total Spent (in millions)

Comprehensive Community Support Service Spending and Clients Served Ages 0-18