CENTENNIAL CARE: NEXT PHASE Kickoff Meeting of the 1115 Waiver Renewal Subcommittee October 14, 2016 New Mexico Human Services Department
Introductions Role of subcommittee Subcommittee guidance Renewal waiver timeline Overview of current waiver Key areas for consideration Renewal waiver Care coordination Meeting close/next steps 2
Provide feedback on key issues for renewal Obtain comprehensive and diverse stakeholder input Provide input early in the process Help to guide development of the concept paper Focus on issues relevant for waiver 3
Guid idance nce fo for Dis r Discussio ssion What is is w waiv iver er vs. . non-wa waiv iver er topic ics s Waiver Non-Waiver System Transformation: Items Policy or implementation that require waiver authority issues to implement New contract terms, process, or tools Eligibility changes or Modification of provider expansions qualifications Benefit packages Implementation of quality strategy and monitoring Financing approaches 4
Subcommittee Begin waiver Tribal Public comment meeting dates: application Waiver consultation 30 days • 10/14/16 (6/16/17) Effective 60 days (10/1/17) • 11/18/16 Date (9/1/17) • 12/16/16 Concept (1/1/2019) Submit waiver • 1/13/17 paper release renewal • 2/10/17 (3/16/17) (12/31/17) Concept paper Waiver Prepare final development application Application (12/16 – 3/17) (6/17-8/17) Tribal (11/17-12/17) Concept paper, consultation and public comment Tribal consultation and (9/17-10/17) public comment (3/17-6/17) 5
Guiding Principles Program Goals To assure that enrollees receive Developing a comprehensive the right amount of care at the service delivery system that right time and in the most cost provides the full array of appropriate or “right” settings benefits and services offered To assure that the care being through the State’s Medicaid purchased by the program is program measured in terms of quality Encouraging more personal and not solely quantity responsibility by members for To bend the cost curve over time their own health Streamline and modernize the Increasing the emphasis on program in preparation for the payment reforms that pay for potential increase in quality rather than for quantity membership of up to 175,000 of services delivered individuals beginning Simplifying administration of the January 2014 program for the state, for providers and for members where possible 6
Care coordination Native American BH participation integration and protection Centennial Care Safety net Delivery care pool system Home and Centennial Community Rewards Based Services 7
Cu Curr rrent nt Pr Progra ram m Su Successes esses Care coordination Principle 1 950 care coordinators 60,000 in care coordination L2 and L3 Creating a Focus on high cost/high need members comprehensive delivery system Health risk assessment Standardized HRA across MCOs 610,000 HRAs Build a care coordination Increased use of community health workers infrastructure for 100+ employed by MCOs members with more complex needs that Increase in members served by PCMH coordinates the full 200k to 250k between 2014 and 2015 array of services in an integrated, Telemedicine – 45% increase over 2014 person-centered Health Home – Implemented Clovis and San Juan model of care (SMI/SED) Expanding HCBS - 85.5% in community and increasing community benefit services Electronic visit verification Reduction in the use of ED for non-emergent conditions 8
Cu Curr rrent nt Pr Progra ram m Su Successes esses Principle 2 Centennial Rewards health risk assessments dental visits Encouraging Personal bone density screenings Responsibility refilling asthma inhalers diabetic screenings refilling medications for bipolar disorder and schizophrenia Offer a member rewards program to incentivize members 70% participation in rewards program to engage in healthy Majority participate via mobile devices behaviors Estimated cost savings in 2015: $23 million Reduced IP admissions 43% higher asthma controller refill adherence 40% higher HbA1c test compliance 76% higher medication adherence for individuals with schizophrenia 70k members participating in step-up challenge 9
Curr Cu rrent nt Pr Progra ram m Su Successes esses Principle 3 July 2015, 10 pilot projects approved ACO-like models Bundled payments Increasing Emphasis Shared savings on Payment Reforms Developed quarterly reporting templates and agreed-upon set of metrics that included process Create an incentive measures and efficiency metrics payment program that rewards providers for Subcapitated payment for defined population performance on Three-tiered reimbursement for PCMHs quality and outcome Bundled payments for episodes of care measures that PCMH Shared Savings improve members Obstetrics gain sharing health Implemented minimum payment reform thresholds for provider payments in CY2017 in MCO contracts 10
Curr Cu rrent nt Pr Progra ram m Su Successes esses Consolidation of 11 different federal waivers that siloed Principle 4 care by category of eligibility; reduce number of MCOs and require each MCO to deliver the full array of Simplify benefits; streamline application and enrollment Administration processes for members; and develop strategies with MCOs to reduce provider administrative burden Create a coordinated One application for Medicaid and subsidized coverage delivery system that through the Marketplace focuses on integrated care and improved Streamlined enrollment and re-certifications health outcomes; increases accountability for MCO provider billing training around the State for all BH more limited number providers and Nursing Facilities of MCOs and reduces Standardized the BH prior authorization form for administrative managed care and FFS burden for both Standardized the BH level of care guidelines providers and Standardized the facility/organization credentialing members application Standardized the single ownership and controlling interest disclosure form for credentialing. Created FAQs for credentialing and BH provider billing 11
Future ture Ou Outlo tlook ok and d Op Opportun portunities ities Outlook As Medicaid approaches covering almost half of New Mexico’s two million population, immense opportunity to drive value and health outcomes for our State Continued Medicaid enrollment growth/spending growth combined with reduced oil and gas revenue and an aging population continue to drive — Innovations for LTSS program and better management of dually- eligible population Advancement of value-based purchasing arrangements Strategies to improve care for high utilizers — 5 percent of members who account for 50% of spend Opportunities Continue to build upon existing waiver goals and principles Improve engagement for unreachable members Appropriate level of care coordination for high need populations Performance incentives for MCOs and providers 12
Dece ecember ber 16, 2016 Febru bruary ry 10, 0, 2017 17 Octob tober r 14, , 2016 • BH-PH integration • Benefit and • Goals & objectives eligibility review • Long term services • Waiver background and supports • Care coordination Octo tober r 2016 16 Novem ember r 2016 16 Decem ecember er 2016 January uary 2017 Febru ruary ry 2017 January uary 13, 3, 2017 17 Novem vembe ber r 18, , 2016 • Value based • Care coordination purchasing • Population health • Personal responsibility 13
Areas of Focus 14
Refine care coordination Expand value based purchasing Continue efforts for BH & PH integration Address population health Opportunities to enhance long term services and supports Provider adequacy Benefit alignment and member responsibility 15
Improve transitions of care Focus on higher need populations Provider’s role in care coordination 16
1. Impro prove ve Tran ansi siti tions ons of Care re Follow-up after 7 days Readmission rates Care Coordination chart audits demonstrating opportunities to improve transitions of care There is also evidence in Care Coordination audits that suggest a higher-level of care coordination is needed during these critical transitions Benef nefit it Chall llenge enges Ques estio ions/F /Feed edback ck 1. What is the value of this Reduce readmissions Communication with initiative to the program Improve member hospitals/facilities overall? confidence in their Engagement of family and 2. What are strategies to healthcare and providers other community improve communication between MCOs and Ensure care delivered in supports Providers? the right place Member adherence to 3. What are strategies to recommended follow-up better engage families? 4. What is the capacity to increase planning and follow-up by care coordinators? 17
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