Michigan Department of Community Health

Director Olga Dazzo

Michigan’s Plan for Integrated CareNational Academy for State Health Policy

Kansas City, MissouriOctober 5, 2011

2Yontz

Michigan’s Health Care Priorities

• Improve health status of Michigan citizens• Improve health care system• Lower health care costs• Implement provisions of health care reform

3Yontz

Current Environment

• Medicare and Medicaid spending > $7 billion for 207,000+ duals

• State spend primarily on nursing facility care and behavioral health services

• Primarily an older female and younger male demographic

• Multiple chronic health conditionsData source: 2008 Michigan Medicaid Data Warehouse and ResDAC Medicare Data

4Yontz

Current Environment

• Managed care physical health and behavioral health systems for Medicaid benefit

• Little managed care for Medicare benefit

• Waiting list for long term care HCBS

• Multiple case managers for people receiving services

5Yontz

Basic Demographics

Gender Age

Under 65 Over 65 Total

Female 64,539 71,725 136,264

Male 55,268 30,155 85,423

Total 119,807 101,880 221,687Source: Michigan Medicaid Data Warehouse – 2010 Unduplicated Count of Beneficiaries

6Yontz

Chronic ConditionsCondition Number of

IndividualsPercent of

Duals

Ischemic Heart Disease 70,650 34%

Diabetes 64,570 31%

Depression 53,425 26%

Chronic Heart Failure 49,496 24%

Arthritis 48,491 23%

Behavioral Health 41,863 20%

Alzheimer Related Disease 37,872 18%

Chronic Obstructive Pulmonary Disease 36,754 18%

Chronic Kidney Disease 33,058 16%

Cataract 21,852 11%

Osteoporosis 20,060 10%

Alzheimer’s Disease 19,844 10%Source: Medicare Chronic Condition Warehouse for 2009

7Yontz

Multiple Conditions

0%2%4%6%8%

10%12%14%16%18%20%

Percent of Duals Population

0 1 2 3 4 5 6+

Number of Chronic Conditions

Source: Medicare Chronic Condition Warehouse for 2009

8Yontz

Overview of Proposed Approach

• Provide all covered services for dually eligible beneficiaries through single contracted entity

• Feature auto-enrollment with opt out

• Design robust care coordination program with health home and person-centered focus

9Yontz

Overview of Proposed Approach

• Integrate funds at the state level with full or shared risk/shared savings model

• Acuity-based capitation arrangement with contracted entities (no pre-selected model)

• Shared risk initially between Medicaid and contracted entities

10Yontz

Core Program Elements

• All core Medicare and Medicaid services • Comprehensive provider network• Single standardized assessment tool• Person-centered planning• Person-centered health homes • Care coordinator or team for each participant• Family caregiver involvement

11Yontz

Core Program Elements

• Strong HCBS options• Performance evaluation metrics • Quality management strategies and

measurements• Data sharing to enhance care coordination• Auto enrollment with opt out• Enrollee protections that meet Medicare and

Medicaid standards

12Yontz

Stakeholder Process

• Informant Interviews

• Regional Forums

• Request for Input

• Topic-Driven Workgroups

• E-mail box

13Yontz

Things to Think About (or early lessons learned)

• Prepare for difficult conversations

• Early data acquisition and analysis

• Dedicate staff for project planning and development

• Develop public relations strategy

• Listen

14Yontz

Contact Information

Susan Yontz, DirectorLong Term Care Services DivisionMedical Services Administration

yontzs@michigan.gov