renee markus hodin community catalyst from vision to reality: state strategies for health reform...
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Renee Markus HodinCommunity CatalystFrom Vision to Reality: State Strategies for Health Reform ImplementationNovember 2010
Payment & Delivery System Reform in Medicaid:
Opportunities in the ACA
© Community Catalyst 2010
Why Should We Care?
Improve Care For the Most Vulnerable
© Community Catalyst 2010
Improve Care for Most Vulnerable (cont’d)
© Community Catalyst 2010
Source: “The State of Health Care Quality”, 2009, NCQA
Sustain the Medicaid Program
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Medicaid is:
• critical to 45 million+ low income and vulnerable people
• the foundation for and key building block of the coverage expansion in 2014
• under enormous fiscal pressure
Sustain the Medicaid Program (cont’d)
© Community Catalyst 2010
• 46 States plus DC need to close budget gaps
• Aggregate State Budget Shortfall (FY11) =$121 billion
• State revenue still below pre-recession levels
• Continued high unemployment/ growth in poverty drive Medicaid caseload
• Add’l FMAP ending?
© Community Catalyst 2010
Opportunities in the ACA
© Community Catalyst 2010
• Grants to promote healthy behaviors in Medicaid (2011)
• $100 million appropriated
• Incentives to cover preventive services in Medicaid (2013)
• 1% increase in state FMAP
New Focus on Prevention
Improve Care Coordination
© Community Catalyst 2010
• Center for Medicare and Medicaid Innovation (2011 & beyond)
• Federal Coordinated Health Care Office (2010)
• Medical Homes state option (2011)
• 90% FMAP for 1st two years
Explore New Ways to Pay for Care
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• Bundled payments (Oct 2011)
• 8 states
• Global payments (FY2010-FY2012)
• 5 states
• Pediatric ACOs (Jan 2010 – Dec 2016)
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• HCBS State Plan Option Expansion (immediate)
• Money Follows the Person Demonstration Extension (immediate)
• Community First Choice Option (Oct 2011)
• State Balancing Incentive Program (Oct 2011)
Strengthen Long-Term Care
© Community Catalyst 2010
No federal payments for preventable errors (July 2011)
Reduce Medical Errors
© Community Catalyst 2010
Key Takeaways
© Community Catalyst 2010
Key Takeaways
1. Sustaining the Medicaid program is essential work between now and 2014
2. Key to that work is proposing payment & delivery system reforms that improve care while reducing costs (as alternatives to other Medicaid cuts)
3. The ACA includes payment & delivery system reform options, but states must act to take advantage of them – advocates can help!