briefing on medicaid managed care alliance for health reform october 28, 2011 missouri medicaid and...
TRANSCRIPT
Briefing on Medicaid Managed Care Alliance for Health Reform
October 28, 2011
Missouri Medicaid and Managed Care:What Are We Buying?
Ian McCaslin, M.D., M.P.H.Director, MO HealthNet
Missouri Dept. of Social Services
• OUR EMPHASIS is to increase the health status of Missourians through better:–Coverage for health care services–Access to those services–Quality of those services–Accountability to taxpayers
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Items Funded with General Revenue:
– MO HealthNet ($1.2 billion)– Elementary and Second. Education ($2.75 billion)
– Higher Education ($834.1 million)– Non-Medicaid Social Services ($350.3 million)
– Corrections ($595.3 million)– Mental Health ($563.5 million)– Judiciary ($170.1 million)
TAFP After Veto FY 2012 3
Source: DSS Annual Table 23
Managed Care Eligibility
Not Allowed by Statute Statewide:- Permanently and Totally Disabled- The Elderly
Mandated in 54 Counties: - Children- Pregnant Women- Very Low Income Parents and Caretakers- Certain Exceptions 5
Number of Counties
Central Region (28 )
Eastern Region (13 )
Western Region (13 )
CEDAR
MADISON
PERRY
PIKE
MARIES
HOWARD
PETTIS
MORGAN
COLE
MONITEAU
MILLER
CAMDEN
MO
NTG
OM
ERY
LINN
BOLL
ING
ER
PHELPS
STODDARD
DEKALB
LAFAYETTE
ST CLAIR
STFRANCOIS
ST CHARLES4
LINCOLN
CARROLL
CAPEGIRARDEAU
CRAWFORD
DENT
CARTER
GREENE
CHRISTIAN DOUGLAS
OREGON
NEWTON
JASPER
BARTON
BENTON
HICKORY
POLK
DALLAS
LACLEDE
CALLAWAY
BOONE
CHARITON
MARION
SHELBY
SCOTLAND
SULLIVAN
PUTNAM MERCER
GRUNDY
LIVINGSTON
CALDWELL
RAYCLAY
CLINTON
HOLT ANDRE
W
GENTRY
WORTH
HARRISON
ADAIR LEWIS
CLARK
SCHUYLER
KNOX
MACON
HOWELL
TEXAS
PULASKI
RANDOLPH
MONROE
RALLS
AUDRAIN
OSAGE
WASHINGTON
STEGENEVIEVE
IRON
REYNOLDS
SHANNON
WAYNE
RIPLEY
BUTLER
SCOTT
MISSISSIPPI
NEW MADRID
DUNKLIN
PEMISCOT
OZARK
WRIGHT
ATCHISON
NODAWAY
DAVIESS
SALINE
COOPER
BATES
HENRY
VERNON
DADE
LAWRENCE
MCDONALD
BARRY
STONE
TANEY
WEBSTER
WARREN
FRANKLIN
ST LOUIS
COUNTY
JEFFERSON
<<< ST LOUIS
CITY
CASS
JACKSON
JOHNSON
PLATTE
BUCHANAN
GAS
CON
ADE
MissouriManaged Care
Regions
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Medicaid Managed Care Trends
Source: CMS as of 06/09;DSS Monthly Management Reports, Table 23
% Total Eligibles
Enrolled in Managed
Care
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Is Managed Care Good for Patients? Defined Access Standards
Required Adequate Provider Network
Defined Appointment Standards
Yearly Member Satisfaction Surveys
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Quality Provisions
Performance Standards - Well-child visits, including Adolescent Access
- Case Management of High Needs IndividualsBehavioral HealthHigh Risk PregnancySpecial Needs Children
- Healthcare Effectiveness Measures (HEDIS) 9
Costs Monthly Capitation Payments based on Certified
Actuarially Sound Rates
Overall Managed care cost FY-2011 $1.04b
CMS Requires Cost Effectiveness over Two Year Period
External Evaluation of FY-2009 Managed Care vs FFS Demonstrated Savings of 2.7%, or $38 million, compared with a FFS Structure
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Concerns with Managed Care Health Plans Vary in their Performance
Doctors, Clinics, Hospitals Dislike the Administrative and Contracting Burden
Evidence Exists that the “Value-added” Services of Managed Care are not Always Delivered Adequately
State Staff Contract Compliance of Health Plan Performance Requires a Lot of Resources to Do Well
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Missouri Medicaid and Managed Care:What Are We Buying?
Accountability for Access to Care and Quality of Care
Predictability of Budgeting
A Cost-effective Delivery System
State Enhanced Focus on Value is Paying Off
Effective Compliance Monitoring is Critical12
Missouri’s Medicaid Program
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