district of columbia’s public health care programs in a post reform environment presentation for...
TRANSCRIPT
District of Columbia’s Public Health Care Programs in a Post
Reform Environment
Presentation for the:
Health Insurance Forum
Department of Health Care FinanceMay 26, 2011
Washington DC
Presentation Outline
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Overview of District’s Medicaid Program
Broad Goals of Health Care Reform Increased Access Through Program Expansion Service Delivery Reform To Promote Quality Increased Coverage Through Exchange
Mayor’s Health Care Reform Implementation Committee
Key Facts About the Department of Health Care Finance
Total Agency FY12 Budget Exceeds $2.1 Billion
96% of budget spent on Provider Payments
Hospitals Managed Care Organizations Institutional Care (e.g. Nursing Homes) Physician Payments
DC Medicaid provides health insurance coverage to almost 1 in 3 District residents – over 180,000 people
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Managed Care Is A Growing Component of Medicaid in the District of Columbia
Notes: D.C. fiscal year is October 1 through September 30; enrollment was averaged from October to September to create average monthly enrollment. Data were not available for managed care and fee for service enrollment prior to FY2007. Due to new coverage option state plan amendment and an 1115 waiver for childless adult beneficiaries with incomes between 133 percent and 200 percent of the Federal Poverty Level, over 30,000 individuals were moved from Alliance (not included in the data above) onto the Medicaid program. The net result is a rapid increase in managed care enrollment in FY2010 and FY2011, when looking at Medicaid enrollment data only.
36% 37%37%
64%
33%
67%63%63%
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The Elderly And Disabled Represent 29 Percent Of Medicaid Program Beneficiaries
Demographics Of Beneficiaries In The District of Columbia’s Medicaid Program
Adults
Blind & Disabled
AgedChildren
29%
Notes: Distributions may not sum to 100% due to rounding effects. Distribution of beneficiaries by category is based on average Medicaid enrollment in FY10.
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…Yet They Account For 73 Percent Of Medicaid Program Spending, FY10
Children
Adults
Blind & Disabled
Aged
Notes: Distributions may not sum to 100% due to rounding effects.
Source: Spending from ad hoc MMIS report 1/26/2011. FY 2010 date-of-service spending excluding DSH, cost settlements, Medicare premiums, and drug rebate.
Children
Adults
Blind & Disabled
Aged
29%
73%
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The Cost of Serving the Elderly and Disabled Is Substantially Greater Than The Cost of
Care For Children in Medicaid, FY10
Source: Spending from ad hoc MMIS report 1/26/2011. FY 2010 date-of-service spending excluding DSH, cost settlements, Medicare premiums, and drug rebate. 7
Presentation Outline
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Overview of District’s Medicaid Program
Broad Goals of Health Care Reform Increased Access Through Program Expansion Service Delivery Reform To Promote Quality Increased Coverage Through Exchange
Mayor’s Health Care Reform Implementation Committee
Broad Goals of Health Care Reform Fit Neatly With District’s History and Focus On
The Uninsured
New law requires States to expand the Medicaid program to all persons under age 65 with incomes up to 133% of FPL
Undocumented immigrants are not eligible
Federal government will pay:100% of this expansion for years (2014-16) 95% in 2017 94% in 201893% in 2019 90% for 2020 and beyond
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DC’s Current Medicaid Eligibility Levels Already Exceed Targeted Thresholds For Health Reform
Medicaid Eligibility Groups
$14,483
2014 Heath ReformEligibility Threshold
133% of Federal Poverty(Family of One) $21,780
$32,670$32,670
$21,780
Families w/
Children
Children Age (0-18)
Pregnant Women
Childless Adults
(Medicaid)
Institutionand
Waiver
DC Medicaid Income Eligibility Thresholds As A Percent of Federal Poverty
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$24,176
Note: The District will receive federal support for its eligibility expansion in 2020. Federal government will pay 90% of the cost of expansion..
Health Reform Focus On Quality Could Significantly Impact Programming For
Medicaid In The District
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Significant aspects of the ACA focus on improving the quality of care and by extension patient outcomes
Although spending approaches $2 billion questions persist about the health status of Medicaid and Alliance beneficiaries
Threshold question is how do we strengthen the link between the dollars we spend and better patient outcomes
Progress being made with evidence based approaches to target problems in prenatal care and we are now beginning to seeing fewer adverse prenatal outcomes in the District
Key Questions And Much Work Remain…..
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How do we get beneficiaries to practice preventive health?
Regular visits to primary care and follow regimens Healthier lifestyle choices – health status has complex
social determinants
How do we move beneficiaries away from hospitals as a source of primary care?
Medicaid is too hospital-based ($300 million on inpatient care)
Need more urgent care facilities Better management of patient care
Affordable Care Act Offers Options Through Medical Homes Concept
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Health Homes – law permits Medicaid enrollees with chronic physical or mental health conditions to designate a provider as a health home
Goal is to address care coordination issues Team of health professionals to coordinate and deliver
care A mandated list of comprehensive care management and
social support services Disease management services Prevention services Federal government will pay 90 percent of the cost for 2
years
Affordable Care Act Offers Options Through Accountable Care Organizations
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Accountable Care Organizations – program that ties provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.
Four core principles for all ACOs:
1. Provider-led organizations with a strong base of primary care
2. Payments linked to quality improvements that also reduce overall costs
3. Reliable and progressively more sophisticated performance measurement to support improvement and provide confidence that savings are achieved through improvements in care
4. Shared savings model
Insurance Exchange Is Most Ambitious Goal of Affordable Care Act
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The Affordable Care Act relies on states to establish health insurance exchanges
Goal is to create an insurance marketplaces that provide affordable, good-quality coverage options to individuals and small businesses
Forty-eight States and the District of Columbia were awarded their first Exchange grants in September 2010.
Those grants were for planning purposes and the next round of grants will be for the purpose of establishing an Exchange
DHCF has contracted with Mercer Consulting to provide guidance as to how the District’s Exchange should be constructed
Key Questions……….
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1. Who will have access to the Exchange and how do you avoid the problem of adverse selection?
2. How should the Exchange be structured?
3. How much purchasing authority should an Exchange have?
4. What benefits should be offered in an Exchange?
Presentation Outline
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Overview of District’s Medicaid Program
Broad Goals of Health Care Reform Increased Access Through Program Expansion Service Delivery Reform To Promote Quality Increased Coverage Through Exchange
Mayor’s Health Care Reform Implementation Committee
Mayor Vincent Gray’s Health Reform Implementation Will Advise Him On Health
Reform Policy
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Mayor Vincent C. Gray announced the creation of the Mayor’s Health Reform Implementation Committee (HRIC) in April 2011
The Committee will advise and make recommendations to the Mayor’s office on the implementation of the Affordable Care Act
The panel will be chaired by Wayne Turnage, Director of the Department of Health Care Finance and co-chaired by Department of Health Director Dr. Mohammad Akhter and Department of Insurance, Securities and Banking Commissioner William White.
Mayor Vincent Gray’s Health Reform Implementation Will Advise Him On Health
Reform Policy
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HRIC will direct the work three subcommittees
Eligibility and Medicaid Expansion Insurance Health Delivery System
Additional committee members will come from related agencies such as the Department of Human Services, the Department of Mental Health and the Department of Disability Services
The committee will submit its recommendations to Deputy Mayor for Health and Human Services B.B. Otero so that her office can ensure interagency coordination in implementing the committee’s recommendations