[PDF] - The Journey to Healthcare Redesign in Mississippi Timothy H. Moore PDF Document

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The Journey to Healthcare Redesign in Mississippi

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Timothy H. Moore President / CEO

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“The significant problems we face cannot be solved by the same level of thinking that created them.” Albert Einstein

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The he Cen Central Ten endency of

f

Ou Our Ch Chall llenges ha have Res esided in this is Buil Buildin ing.

The Mississippi State Capitol

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Remember Apollo 13

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99 Acute Hospitals in the State
49 facilities have 50 or less beds
39 CAH
Serving 82 counties
Average county is 591 square miles
Approximate population of 3 million
6 facilities have closed since 2010
5 major systems in the state
Limited overlap of service
Jackson Metro area: Madison, Hinds, Rankin
The gulf coast: Harrison, Jackson
The map indicates the rural nature of the state

Mississippi Hospital Facts

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2013

Initial Discussions with the Governor

2014

Medicaid Redesign Committee
Explored Options to work/partner with MCOs
Selection of a Partner
Playbook Presented to the Governor

2015

Provider Sponsored Plan (PSP) defined by Statute SB 2441
Medicaid not mandated to use PSP

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2016

No Medicaid Action taken
Member Education

2017

Medicaid Submits RFP in February
MsTrue Submitted Response in April
Bids Awarded in June

2018

House passes (117-1) Carve-out legislation favorable to MsTrue
Year for Medicaid Reauthorization
Lt. Governor Attempts to let the Authorization Die in the Senate
MsTrue was sacrificed to retain protection provided in the legislation
MHA Reopened Discussions regarding Statewide ACO
Established Myriad Healthcare

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2019

Development of MsCares Proposal for Access to Care
Announced at the Capitol on May 13th , Monday of National Hospital Week
Extensive Educational Road Tour Across the State
Election Year- Candidates of Both Parties supported the Proposal with one Exception

2020

Former Lt. Governor Tate Reeves with a 3% Victory Margin is Sworn in as Governor
COVID-19 Hits
All Healthcare Issues Pushed to Next Session with Some Exception – Cares Funding
Greater Utilization of External Groups to Promote Medicaid Expansion

2021

Reauthorization of the Medicaid Program
Poor Economic Outlook for the State
Double Digit Unemployment
The Fears and Unknow of COVID-119

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Fiscal Challenges for Mississippi Hospitals

Reductions in Medicare Inpatient and Outpatient

Market basket Increases through 2027 - $3 Billion

Medicare DSH and Sequestration and Other Cuts

Projected Through 2027 - $1.7 Billion

Since 2010, 6 hospital closures – Belzoni, Kilmichael,

Natchez, Newton, Marks, Senatobia

Since 2010, 6 hospital bankruptcies – Natchez,

Clarksdale, Batesville, Aberdeen, Amory, Magee

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Statistics for Mississippi Hospitals

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MS

Nat. AVG

Average Mcare Utilization($) 52% 45%-61% Average Mcaid Utilization($) 15% 8%-22% Average Mcaid MCO Utilization($) 65% 25%-86% Expense per Staffed Bed $623,336 $1,225,455 Outpatient Revenue %58 %59 Age of Plant 33 yrs 19yrs IT Operating Expense %2 %12

Mississippi Hospitals - Payer Mix Q1-3, 2019

Blue Cross Blue Shield

15.49%

Other - 3.73% Commercial Insurance

13.06%

Medicaid FFS - 5.04% Magnolia Health - 7.19% Molina Healthcare - 2.14% United Healthcare - 5.71% Self Pay - 10.10% Medicare - 31.63% Medicare Advantage - 5.92%

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Hospitals – Medicaid Inpatient SFY 2013-18

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648,729,141 671,151,312 658,486,490 580,915,145 576,019,642 600,662,599 520,000,000 540,000,000 560,000,000 580,000,000 600,000,000 620,000,000 640,000,000 660,000,000 680,000,000 2013 2014 2015 2016 2017 2018

Hospitals – Medicaid Outpatient SFY 2013-18

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278,613,836 274,754,394 327,527,599 366,734,630 407,653,121 419,523,868

50,000,000

100,000,000 150,000,000 200,000,000 250,000,000 300,000,000 350,000,000 400,000,000 450,000,000 2013 2014 2015 2016 2017 2018

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Provider Taxes By Mississippi Hospitals

For SFY 2020, Mississippi hospitals will pay the

entire state share for hospital access payments, $122,190,418 to receive $527,364,770.

For SFY 2020, Mississippi hospitals will pay the

entire state share for Disproportionate Share Hospital Payments, $53,328,509 to receive $231,661,637.

For SFY 2020, Mississippi hospitals will pay an

additional $100,878,125 to support the state share used for hospital payments.

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Medicaid and Medicaid Managed Care

Admin. Costs for MCOs exceed $1.3B since 2011
SFY 2019 total program admin approx. $400M
$750M for SFY 2011 direct state appropriation

June 2011 enrollment: Total – 707,450; MCO < 200,000

$931M for SFY 2020 direct state appropriation

December 2019 enrollment: Total - 715,815; MCO - 438,029

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Holding the Line on Expenses

Mississippi non-profit hospitals have the lowest

national inpatient per diem expenses - $1,365/day.

Mississippi state and local government hospitals

have the 8th lowest national inpatient per diem expenses - $1,239/day.

Mississippi for profit hospitals have the 12th lowest

national inpatient per diem expenses - $1,762/day.

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”Slick” Willie Sutton

Sutton’s Law

11 year career in Bank Robbery.
Over $2 million stolen.
Instrument used to train med students.
Sutton confessed he never said it.
“If anybody had asked me, I’d have probably said it.” …it

couldn’t be more obvious.

Created by a young reporter, Mitch Ohnstad

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MississippiCares

a proposal by the Mississippi Hospital

Don’t

verlook the
bvious !

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How We Got Here . . . .

MS Labor Force 1/12: 1,332,527
MS Labor Force 7/19: 1,276,286
MS Employed 1/12: 1,209,512
MS Employed 7/19: 1,211,467
Unemployment rate is 2nd

highest in the country and on the rise since June 2018

$624M uncompensated care
Medicare 2012: 516,809
Medicare 2019: 648,047
48th in employer coverage
6th in percentage of uninsured
Highest Medicaid percentage
f any non-expansion state
NO to ObamaCare!!!
How does the State pay its

share?

What if the Feds stop funding

the program?

What if the ACA repealed?
Don’t want to expand a

broken program

Mississippi Workforce Mississippi Hospitals Mississippi Leadership

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A Broken Program . . . .

Since 2011 $1B in admin fees for MCOs
$240M SFY 18 for admin fees to MCOs
$160M SFY 18 for admin fees to Medicaid

Administrative Cost

ER cost up 155%
ER visits up 46%
EPSDT (well-child) screenings down 19%
Persistent Asthmatics w/ meds down 14%

Medicaid Quality

$7,377 per beneficiary 2014
$8,751 per beneficiary 2019
Total enrollment differs by 10 enrollees
$1,400 increase (19%) per beneficiary

6 Year Cost Comparison

Denied Treatments
Delayed or denied payments
Delayed Provider Credentialing/Enrollment
Limited responsiveness

Reported Provider Issues

Mississippi ranks #1 in medical debt, yet we rank 34th in medical spending, and 49th in

verall national health ranking.

Emphasizing the high need for care and the inability to pay for that care.

How Do We Pay for It?

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Enrollment (Plan Members) 100,000 150,000 200,000 250,000 300,000 350,000 Inclusive Premium Cost per Member $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 Total Premium Payment $500M $750M $1B $1.25B $1.5B $1.75B 10% State Share Needed to Fund Premiums $50M $75M $100M $125M $150M $175M Funded by Plan Member @ $20/mo. $24M $36M $48M $60M $72M $84M Funded by Hospital Investment/Tax $26M $39M $52M $65M $78M $91M 3% Premium Tax Generated for State of MS

$15M $22.5M $30M $37.5M $45M $52.5M

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ACOs in Mississippi

Currently 8 MSSP ACOs operating in Mississippi.
Large part of rural Mississippi not included.
5,000 Medicare lives to establish an ACO.
Concerns that those rural areas could be blocked out of

participating in MSSP ACO.

Why MHA Star arted a a State-wide ACO an and its its Curr urrent t Statu tus

The growing possibility of Rural hospitals not having the opportunity to

participate in a MSSP ACO.

The deteriorating relationship with payors, specifically the MCOs.
MHA needed a partner that had the knowledge and expertise to assist in

the development of a State-wide ACO.

Caravan Health already had a presence in Mississippi and was

recommended by members currently utilizing their services.

Probability of acquiring 60,000 Medicare lives, which reduces the floor for

shared savings from 3.9% down to 2%.

All inclusive the MHA Board of Governors supported the sponsoring of a

State-wide ACO.

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Start art of

f ACO (c

(conti tinued)

Caravan Health was able to secure and merge into a 2018 Track 1 ACO

under the old regulations with 2 years remaining in a 3-year contract with CMS. This allowed our ACO several benefits:

1) Myriad accepted 2 years of one-sided risk understanding a decision

regarding new ACO models would have to be made to proceed with CMS long term, the Cares Act has extended one-sided risk for an additional year. Due to the uncertainty of the pandemic other changes could occur before a transition to another model is required.

2) The participants are now in year two of a three-year contract for (the
riginal 2 and 1 additional year due to COVID-19) 50% shared savings versus

25% under the newer revised regulations.

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Start art of

f ACO (c

(conti tinued)

There are 28 Mississippi hospitals participating in the MHA sponsored

MSSP ACO with an approximately 79,000 Medicare lives.

11 of those hospitals are CAHs
6 PPS hospitals 50 beds or less.
The MHA sponsored ACO is a stand alone L.L.C. (Myriad Healthcare)
owned and operated by participating hospitals.
Each hospital participating has a seat on the board of the ACO.
Clinically Integrated Network

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Development of Large Clinically Integrated Network (CIN)

The ACO itself becomes a Clinically Integrated Network (CIN) and

contracting with other ACOs in the State creates a large in State CIN.

The CIN provides data on a grander scale.
Data is essential in order to consider full risk arrangements. As with

any insurance product large numbers are important. In the ACO or CIN the more lives you have the better you mitigate risk.

The CIN can negotiate managed care and commercial payer contracts

for network providing significant negotiating leverage.

Data! Data! Data!

Curr urrent t Cha hall llenges to

Via

Viabil ilit ity

Varying Experience Levels
Varying Risk Tolerance
Access to Resources
Assessment of Tangible Benefit
Cost

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Develop a Concierge Approach
A la carte Participant Selection
f Service
Increased Education and

Training

Fee Reduction

Solutions

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A common pain shared by all is a tremendous unifier! We are competitors there is no way we can work together?

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Questions and Comments

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THANK YOU

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