6/23/2020 The Journey to Healthcare Redesign in Mississippi Timothy H. Moore President / CEO 6/23/2020 1 “The significant problems we face cannot be solved by the same level of thinking that created them.” Albert Einstein 2 1
6/23/2020 The he Cen Central Ten endency of of Ou Our Ch Chall llenges ha have Res esided in this is Buil Buildin ing. The Mississippi State Capitol 6/23/2020 4 2
6/23/2020 Remember Apollo 13 6/23/2020 5 Mississippi Hospital Facts • 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 6/23/2020 6 3
6/23/2020 T h • Initial Discussions with the Governor 2013 e • Medicaid Redesign Committee J • Explored Options to work/partner with MCOs • Selection of a Partner o 2014 • Playbook Presented to the Governor u r • Provider Sponsored Plan (PSP) defined by Statute SB 2441 n • Medicaid not mandated to use PSP 2015 e y 6/23/2020 7 T h • No Medicaid Action taken • Member Education 2016 e • M edicaid Submits RFP in February J • MsTrue Submitted Response in April 2017 • Bids Awarded in June o u r • 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 n • MsTrue was sacrificed to retain protection provided in the legislation • MHA Reopened Discussions regarding Statewide ACO 2018 • Established Myriad Healthcare e y 6/23/2020 8 4
6/23/2020 T • Development of MsCares Proposal for Access to Care h • Announced at the Capitol on May 13 th , Monday of National Hospital Week • Extensive Educational Road Tour Across the State 2019 e • Election Year- Candidates of Both Parties supported the Proposal with one Exception J • Former Lt. Governor Tate Reeves with a 3% Victory Margin is Sworn in as Governor • COVID-19 Hits o • All Healthcare Issues Pushed to Next Session with Some Exception – Cares Funding 2020 • Greater Utilization of External Groups to Promote Medicaid Expansion u r • Reauthorization of the Medicaid Program • Poor Economic Outlook for the State n • Double Digit Unemployment 2021 • The Fears and Unknow of COVID-119 e y 6/23/2020 9 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 - $1.7 Billion • Since 2010, 6 hospital closures – Belzoni, Kilmichael, Natchez, Newton, Marks, Senatobia • Since 2010, 6 hospital bankruptcies – Natchez, Clarksdale, Batesville, Aberdeen, Amory, Magee 10 5
6/23/2020 Statistics for Mississippi Hospitals MS Nat. AVG Average Mcare Utilization($) 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 11 Mississippi Hospitals - Payer Mix Q1-3, 2019 Medicare Advantage - Blue Cross Blue Shield 5.92% - 15.49% Medicare - 31.63% Other - 3.73% Commercial Insurance - 13.06% Medicaid FFS - 5.04% Magnolia Health - 7.19% Self Pay - 10.10% Molina Healthcare - United Healthcare - 12 2.14% 5.71% 6
6/23/2020 Hospitals – Medicaid Inpatient SFY 2013-18 680,000,000 671,151,312 658,486,490 660,000,000 648,729,141 640,000,000 620,000,000 600,662,599 600,000,000 580,915,145 580,000,000 576,019,642 560,000,000 540,000,000 520,000,000 2013 2014 2015 2016 2017 2018 13 Hospitals – Medicaid Outpatient SFY 2013-18 450,000,000 419,523,868 407,653,121 400,000,000 366,734,630 350,000,000 327,527,599 300,000,000 278,613,836 274,754,394 250,000,000 200,000,000 150,000,000 100,000,000 50,000,000 - 2013 2014 2015 2016 2017 2018 14 7
6/23/2020 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. 15 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 16 8
6/23/2020 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 8 th lowest national inpatient per diem expenses - $1,239/day. • Mississippi for profit hospitals have the 12 th lowest national inpatient per diem expenses - $1,762/day. 17 ”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 9
6/23/2020 Don’t overlook the obvious ! MississippiCares -a proposal by the Mississippi Hospital How We Got Here . . . . Mississippi Workforce Mississippi Leadership Mississippi Hospitals • • • MS Labor Force 1/12: 1,332,527 $624M uncompensated care NO to ObamaCare!!! • • • MS Labor Force 7/19: 1,276,286 Medicare 2012: 516,809 How does the State pay its share? • • MS Employed 1/12: 1,209,512 Medicare 2019: 648,047 • What if the Feds stop funding 48 th in employer coverage • • MS Employed 7/19: 1,211,467 the program? 6 th in percentage of uninsured • Unemployment rate is 2 nd • • What if the ACA repealed? highest in the country and on • Highest Medicaid percentage • the rise since June 2018 Don’t want to expand a of any non-expansion state broken program 20 10
6/23/2020 A Broken Program . . . . Administrative • Since 2011 $1B in admin fees for MCOs • $240M SFY 18 for admin fees to MCOs Cost • $160M SFY 18 for admin fees to Medicaid Mississippi ranks #1 in medical • ER cost up 155% debt , yet we rank 34 th in Medicaid • ER visits up 46% medical spending , and 49 th in • EPSDT (well-child) screenings down 19% Quality • Persistent Asthmatics w/ meds down 14% overall national health ranking . • $7,377 per beneficiary 2014 Emphasizing the high need for 6 Year Cost • $8,751 per beneficiary 2019 care and the inability to pay for • Total enrollment differs by 10 enrollees Comparison • $1,400 increase (19%) per beneficiary that care. • Denied Treatments Reported • Delayed or denied payments • Delayed Provider Credentialing/Enrollment Provider Issues • Limited responsiveness 21 How Do We Pay for It? 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 $15M $22.5M $30M $37.5M $45M $52.5M 3% Premium Tax Generated for State of MS 22 11
6/23/2020 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. 12
Recommend
More recommend
