Medicaid Advisory Committee March 13, 2017 Retreat Oregon State - - PowerPoint PPT Presentation

Medicaid Advisory Committee

March 13, 2017 Retreat Oregon State Library Salem, Oregon

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9:30- 9:45 Welcome, overview and introductions Laura Etherton, Jeremiah Rigsby, Diana Bianco 9:45- 10:15 History and context of the MAC

• Statue and Charter
• Accomplishments

Amanda Peden Bob DiPrete 10:15- 11:20 The role of the MAC Lori Coyner Laura Etherton, Jeremiah Rigsby 11:20- 11:50 MAC relationship with other entities 11:50 Lunch (Boxed lunches will be provided) 12:00- 12:30 Business section: Presentation & discussion on eligibility and enrollment Lori Coyner 12:30- 1:45 2017 priorities and workplan Amanda Peden, Diana Bianco 1:45- 2:15 Getting the work done 2:15- 2:30 Summary and Next Steps Diana Bianco

Welcome, Overview & Introduction

MAC Members: Why do you serve on the MAC?

History and Context of the MAC

Amanda Peden, OHA Bob DiPrete, MAC

MAC and Oregon Statute

• No more than 15 governor appointed members
• Members can serve up to two, two‐year terms
• Membership must include:

– Health care providers and allied health care professionals, including persons associated with CCOs and other health care organizations – Members of health care consumer groups that include Medicaid recipients – Two OHP members – Directors of the OHA and DHS or designee(s)

• Advise Directors of OHA and DHS on policy, benefits,

structure of Oregon Health Plan 5

MAC Charter Adopted 2015 (full charter in materials)

• Develop and advise policy recommendations at the direction
• f the Governor, the Legislature and OHA
• Key functions are monitoring, advising, policy development

and reporting (see annual charter report)

• Guiding principles: promote quality, affordable, equitable

coverage; consider subpopulations; balance consumer needs with operational/financial considerations

• Alignment and coordination with OHA, OHP leadership,

Oregon Health Policy Board, Legislature 6

Accomplishments: MAC and Oregon Health Plan Development

Inputs

• Policy framework from executive and legislative branches
• Expert testimony from clinicians and other professionals
• Consumer and community preferences and priorities

Process

• Develop goals from policy framework
• Develop work plan based on goals and timeframe
• Analyze expert testimony and consumer and community preferences
• Reach consensus

Outputs

• Policy recommendations

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Accomplishments: MAC and Healthy Kids

Inputs

• Charge and policy framework from executive branch
• Expert testimony from health services researchers and data review
• Consumer and community preferences and priorities

Process

• Set guiding principles for recommendations
• Reviewed state data on children’s access
• Held six community meetings to gather statewide public input
• Analyze expert testimony and consumer and community preferences
• Reach consensus

Outputs

• Policy recommendations for program design

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Accomplishments: MAC and Oral Health Access Framework

Inputs

• Request and guiding questions from OHA
• Input/development of framework by work group of oral health experts
• Consumer and community identified barriers and opportunities

Process

• Create limited duration work group
• Staff support to gather community feedback
• Intersperse work group process with MAC input/guidance
• Work group develop framework products for review by MAC
• Reach consensus

Outputs

• Recommendations for access framework and monitoring

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The Role of the MAC

Lori Coyner, Medicaid Director, OHA Laura Etherton & Jeremiah Rigsby, MAC Co‐Chairs

MAC Relationship with other Entities

Lunch Break/Business Session OHP Eligibility and Enrollment

Lori Coyner, Medicaid Director, OHA

2017 Priorities and Workplan

Amanda Peden, OHA Diana Bianco, Facilitator

Committee Principles – April 2015 Charter

• Promote coverage options that maximize quality, affordable

and equitable benefit coverage, ensure access and continuity

• f care, and result in the lowest net level of churn for OHP

members;

• Consider the health and support needs of diverse

subpopulations, including but not limited to parents, women, children, seniors, persons with disabilities, communities experiencing health inequities, and residents in rural and frontier areas, among others served by OHP; and

• Balance consumer needs with the need for financial viability

and operational self‐sufficiency in the state Medicaid program, the health care delivery system, and other health insurance markets, as appropriate. 14

Coordination of Long Term Services and Supports

Issue

• CCO and Long Term Services and Supports systems

separate delivery and funding

• Coordination of services critical to improve health and

moderate costs

• Accountability systems and strategies in place, but

coordination can be improved MAC role Examine implementation of LTSS coordination within CCO context, develop recommendations for improving care coordination and integration to OHA and DHS Policy questions

• What is the vision of more enhanced coordination

between these systems of care?

• What is an ideal system and what does progress

look like?

• What are promising models of better coordination?
• What changes could be made to accountability or

increased incentives to improve coordination? Product Report on policy recommendations for the future of CCO/LTSS care coordination

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Medicaid for Justice-involved Individuals

Issue

• Improving access to coverage and care, and addressing

social determinants of health for justice-involved individuals can help cut costs, improve population health, prevent recidivism

• Oregon has made progress on connecting justice-involved

individuals to coverage, but more work is needed MAC role Identifying short, longer term policy options to improve care coordination/transitions to community health and social supports from the perspective of Oregon’s transformed delivery system Policy questions

• How can CCOs be incentivized to provide targeted care

coordination and transition supports for justice-involved individuals?

• What models locally and nationally can Oregon draw from

to improve health care coordination and transitions to care for the justice-involved population? Product Report on short and long term policy recommendations to target care coordination and supports to the justice-involved population

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Social Determinants of Health

Issue Growing focus on addressing social and environmental determinants (e.g. housing, education, food, transportation) as a way to achieve health equity and improve individual and population health, while also moderating health care costs. MAC role Assessing and recommending strategies to address social determinants of health as a broad category through the particular lens of Oregon’s Coordinated Care Model and OHP Policy questions

• Are there priority determinants and/or sub populations

where resources should be directed first?

• How can CCOs be held accountable and/or incentivized to

target social determinants of health?

• How can CCOs leverage existing and emerging resources

(e.g. existing policies, workforce) to target attention to social determinants of health?

• What innovative models locally and nationally can Oregon

draw from to improve social determinants of health? Product Framework for addressing social determinants of health in the Coordinated Care Model for OHP, including key policy recommendations

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Federal policy changes

Issue

• Health care is likely to be a focal point in the new

administration, but specific proposals/changes still in question

• Likely proposals will have implications for Oregon’s

Medicaid program MAC role Evaluating federal policy changes through the lens of Oregon’s commitment to the Triple Aim and the Coordinated Care Model Policy questions TBD based on federal policy issues Product TBD based on issue

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Getting the work done

Summary and Next Steps