Strategic Review of the Ohio Department of Medicaid September 4, - - PowerPoint PPT Presentation

Strategic Review of the Ohio Department of Medicaid

September 4, 2018 Loren Anthes, Policy Fellow Center for Medicaid Policy

Strategic Recommendations

• 1. Maintain Current Value-Based Efforts
• 2. Revise MCO Contracts to Account for Social Determinants
• 3. Increase Program Integrity
• 4. Build Consumer-Focused Value
• 5. Look at Non-Medicaid Policies to Affect Health

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KEY RESOURCE

Recommendation 1:

Maintain Current Value Efforts

• Continue the SIM Work
• CPC Results
• Improvements in primary care delivery, including care management for high-risk patients, enhanced access and improved

coordination of care transitions.

• Slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices
• Did not slow Medicare spending – more analysis in Medicaid needed
• Episodes
• Reductions in asthma (21%) and COPD acute exacerbation (18%) spending
• Increases in “commendable” quality level
• Maintain P4P Program in Managed Care
• Increasing risk, considering other options (loss ratio) could be considered
• Maintain Current Eligibility Levels and Processes in Expansion
• Outcomes of expansion include lower cost, better utilization, greater provider participation, increased

economic mobility and reduction in social service need

• Remove all specific ORC controls over rate development

CPC: Health Affairs, June 2018: https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1678 Episodes: http://www.healthpolicyohio.org/wp-content/uploads/2018/04/Moody.pdf Expansion: http://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Final-Report.pdf

Recommendation 2:

Revise Managed Care Contracts to Address Social Determinants

• Managed Care quality is more simplified and improving, but needs refining
• Plan performance is underwhelming in a number of areas
• Medical Loss Ratio Review
• Review MCOs current MLR to ensure compliance with 85% standard
• This threshold can be increased and put at risk
• Other Policy Options
• Classify Certain Social Services Under Medicaid Plan
• Pursue 1115 to establish Coordinated Care Organizations (Oregon Model) or consider

disrupting MCO market by opening up Medicaid ACOs to hospitals

• Value-based purchasing arrangements to require social service investments
• P4P linkage
• Allow “Quality Improvement” activities related to non-benefits to qualify
• Reward effective interventions with higher rates

Medicaid Coverage of Social Interventions, The Milbank Memorial Fund: https://www.milbank.org/publications/medicaid-coverage-social-interventions-road-map-states/

Recommendation 3:

Increase Program Integrity Efforts

• Enhance Efforts to Reducing Fraud, Waste and Abuse
• Examining utilization management tools (Prior Authorization, Rx Lock-In)
• Audit Supplemental Payments and Realign Toward 2025 Standard for Value
• Develop Regulatory Capture Strategy
• Review medical boards with state pricing influence and increase ethics/disclosure

requirements (e.g. Preferred Drug List)

• Make Quality and Cost Transparency a Priority
• Require hospitals publish charge master online, audit, and publish regular reports
• Publish quality data for hospitals, nursing homes, etc., online in a consumer friendly

format

• Re-Examine Community Benefit Standards and Audit “Medicaid shortfall”

Fraud, Waste & Abuse: Link Supplemental Payments: https://www.commonwealthfund.org/publications/fund-reports/2016/nov/integrating-medicaid-supplemental-payments-value-based PDL: https://www.beckershospitalreview.com/supply-chain/texas-aims-to-curb-drugmaker-influence-on-medicaid-preferred-med-decisions.html Chargemaster: https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.0093 Quality Reporting: https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.0093; Community Benefit: https://nashp.org/states-work-to-hold-hospitals-accountable-for-community-benefits-spending/

Recommendation 4:

Build Consumer-Focused Value

• Revise Rate Development and Medical Education Financing to Address Workforce Needs
• Focus on professions associated with ABD (long term care, developmental disabilities, behavioral

health)

• Enable professions focused on primary care, including a review of scope of practice laws that act

as barriers to entry for medically equivalent services

• Revisit GME and Capital Add-on Payments and Align with Value
• Consider Site-Neutrality for Medicaid
• Improve Children’s Health
• Expand School-Based Health
• Include specific Metrics
• Explore Alternative Purchasing Ability Around Rx
• Potential for patent eminent domain and/or 1115 waiver

Nursing Homes: https://www.nytimes.com/2018/07/07/health/nursing-homes-staffing-medicare.html Site Neutrality: https://www.beckershospitalreview.com/finance/12-things-to-know-about-site-neutral-payments.html School Based Health: https://www.macpac.gov/wp-content/uploads/2018/04/Medicaid-in-Schools.pdf Lead Exposure: Link Rx: https://www.communitysolutions.com/medicaid-cuts-innovation-medicaid-pharmacy/

Recommendation 5:

Look at Non-Medicaid Policies to Affect Health

• Increase Housing Trust Fund in Ohio
• Improve Public Transportation
• Consider gas tax public health exemption to allow for resources to go to local

level

• Support conclusions of Ohio Statewide Transit Need Study
• Supplemental Nutrition Assistance Program
• Remove ABAWD work requirement and increase access for seniors
• Workforce Development
• Reduce tuition for primary care professionals

Housing: https://www.enterprisecommunity.org/solutions-and-innovation/health-and-housing SNAP: https://www.communitysolutions.com/arent-older-adults-using-snap/ Transit Needs Study: http://www.dot.state.oh.us/Divisions/Planning/Transit/TransitNeedsStudy/Documents/OhioStatewideTransitNeedsStudyFinalReport.pdf