Commonwealth of Massachusetts Executive Office of Health and Human Services. Massachusetts: Accomplishments and Vision for the Future

Transcription

1 Commonwealth of Massachusetts Executive Office of Health and Human Services Massachusetts: Accomplishments and Vision for the Future

2 Agenda What we ve accomplished Massachusetts Health Reform Phase 1: Expanded Coverage and Access Reform is ongoing Payment Reform/Cost Containment System Transformation Data analytics, exchange, and technology

3 Expanding Coverage and Access: Massachusetts Access to Health Care Uninsurance Percent Uninsurance Health Care Reform 10/06 Population estimates are based on estimates of the total civilian non-institutionalized population in Massachusetts from the March Current Population Survey for the relevant year. Sources: DHCFP Household Surveys for 2000, 2002, 2004, 2006, and 2007; surveys from 2000 through 2006 were conducted February through June of the survey year; survey for 2007 was conducted January through July of Data for 2008, 2009 and 2010 are from the Urban Institute tabulations on the Massachusetts Health Insurance Survey for the respective years. For more information, please visit Click on Publications and Analyses then go to Household Health Insurance Survey. National uninsured rate is as reported by the US Census Bureau in Income, Poverty, and Health Insurance Coverage in the united States, 2008 and 2009 data. Online at 3

4 Expanding Coverage and Access: Individuals Health with Insurance Health Coverage Insurance, (Excludes Medicare Enrollees) +439,343 5,078,377 5,192,814 5,445,375 5,498,991 5,473,460 5,490,099 5,517,720 Jun Dec Dec Dec Dec Dec Mar-11 Notes: Data reflect total enrollment as of the specified date. Totals include Massachusetts residents enrolled in health insurance products offered by the following health plans and their affiliates: Aetna Health, Blue Cross Blue Shield (BCBSMA, HMO Blue and Massachusetts residents insured through other Blue Cross Association plans), Boston Medical Center HealthNet Plan, CeltiCare, CIGNA, ConnectiCare, Fallon, Great-West Health Care, Harvard Pilgrim Health Care, HealthMarkets (MEGA Life and Health Insurance Company, Mid-West National Life Insurance Company of Tennessee, and the Chesapeake Life Insurance Company), Health New England, MassHealth, Neighborhood Health Plan, Tufts, UniCare and UnitedHealthcare. Third quarter enrollment data for Network Health are not included. Data exclude the following insured Massachusetts residents: federal employees not insured through a commercial carrier, active duty military personnel and their families who receive services through Champus/Tricare only, and inmates of the Department of Correction. Numbers may not match previous editions of Key Indicators, as health plans may revise enrollment information in previous quarters. Sources: Membership reported to DHCFP by health plans, and MassHealth; Commonwealth Care enrollment data are from the Health Connector. 4

5 Insured Population by Insurance Type, Health Insurance Coverage Excludes Medicare Enrollees Private Group Individual Purchase MassHealth Commonwealth Care 0% 0% 3% 3% 3% 3% 3% 14% 14% 1% 1% 14% 14% 15% 16% 16% 1% 1% 2% 2% 1% 85% 85% 82% 81% 80% 79% 79% Jun Dec Dec Dec Dec Dec Mar-11 Notes: Private group includes large group, small group, and self-insured members reported by the health plans listed on page 6. Individual purchase includes Commonwealth Choice and residual non-group market. MassHealth enrollment does not include members with partial coverage or premium assistance; they are counted in the private plans. These members include Seniors, MassHealth Limited, individuals with third party liability (e.g., disabled with Medicare), and Family Assistance/Insurance Partnership. Commonwealth Care includes enrollment in Boston Medical Center HealthNet Plan, Fallon, Neighborhood Health Plan. Third quarter enrollment data for Network Health are not included. Data reflect total enrollment, rounded to the nearest thousand, as of the specified date. Totals include Massachusetts residents enrolled in health insurance products offered by the following health plans and their affiliates: Aetna Health, Blue Cross Blue Shield (BCBSMA, HMO Blue and Massachusetts residents insured through other Blue Cross Association plans), Boston Medical Center HealthNet Plan, CeltiCare, CIGNA, ConnectiCare, Fallon, Great-West Health Care, Harvard Pilgrim Health Care, HealthMarkets (MEGA Life and Health Insurance Company, Mid-West National Life Insurance Company of Tennessee, and the Chesapeake Life Insurance Company), Health New England, MassHealth, Neighborhood Health Plan, Network Health, Tufts, UniCare and UnitedHealthcare. Data exclude the following insured MA residents: federal employees not insured through a commercial carrier, active duty military personnel and their families who receive services through Champus/Tricare only and inmates of the Department of Correction. Numbers may not match previous editions of Key Indicators, as health plans may revise enrollment information in previous quarters. Percentages may not sum to 100 due to rounding. Sources: Membership reported to DHCFP by health plans, and MassHealth; Commonwealth Care enrollment data are from the Health Connector. 5

6 Costs of Expansion: Health reform has not been an unreasonable drain on the Massachusetts budget State budget spending on health reform was less than 1% of the state share of the total budget Overall spending on health care reform has been shared Blue Cross Blue Shield Foundation study in May 2009 found that individuals, government and employers have all increased spending on health insurance proportional to their spending prior to reform The economy has made funding all state programs challenging, but has not reduced the commitment to or the need for universal coverage Enhanced federal funding for Medicaid included in federal stimulus bill played an important role in sustaining reform

7 Results and Milestones Universal Coverage: Over 98% of residents and 99.8% of children are covered Access to care: Over 90% of Massachusetts residents have a primary care physician, and 4 out of 5 have seen their doctor in the last 12 months. Employer Coverage: More employers offer health insurance to their employees today than before reforms took effect 78% of Massachusetts employers as compared to the national average of about 69%. Preventive Care: more people are receiving cancer screenings, more women are getting early prenatal care, and non-emergency visits to emergency departments have decreased.

8 Agenda What we ve accomplished Massachusetts Health Reform: Expanding Coverage and Access Reform is ongoing Payment Reform/Cost Containment System Transformation Data analytics, exchange, and technology

9 Need for Cost Containment: Per Capita Spending Is Projected to Nearly Double from 2009 to 2020 Massachusetts Per Capita Personal Health Care Expenditures, $20,000 $18,000 $17,872 $16,000 $14,000 $12,000 $10,000 $9,554 $8,000 $6,683 $6,000 $5,021 $4,000 $3,249 $2,000 $ Note: The health expenditures are defined by residence location and as personal health expenditures by CMS, which exclude expenditures on administration, public health, and construction. Data for are projected. Source: Centers for Medicare & Medicaid Services (CMS), Office of the Actuary, National Health Statistics Group, 2007.

10 Need for Cost Containment: Growth in Health Spending Expected to Surpass Other Economic Indicators Index of Health Expenditures Per Capita and Other Indicators in MA, Per Capita Health Expenditures: 550 in Per Capita GDP: 337 in Wage and Salary: 325 in Consumer Price Index (CPI): 224 in Per Capita Health Expenditures Per Capita GDP Average Wage and Salary CPI Boston Sources: Part I : Per capita health expenditures: Centers for Medicare & Medicaid Services (CMS), Office of the Actuary, National Health Statistics Group, 2007 ( data are projected). Per capita GDP and wage and salary: Regional Economic Information System, Bureau of Economic Analysis, U.S. Department of Commerce. CPI-Urban for Boston area: Bureau of Labor Statistics, U.S. Department of Labor. Part II (except for health spending): US Social Security Administration, The 2008 OASDI Trustees Report, Supplemental Single-Year Tables, intermediate projection, Per capita GDP index: real GDP annual change + GDP price index annual change population annual change; wage index: average annual wage in covered employment.

11 Impact of health care costs on the rest of the economy 1. The relentless rise in health insurance premiums has become one of the greatest challenges facing Massachusetts employers and families. Premium increases continue to outpace growth in the economy and in personal income, straining both businesses and households. Economists have long pointed out that the rapidly rising costs of employer-sponsored health insurance (ESI) have led to slower wage growth in the U.S. and, for some employers, pressure to eliminate jobs or lower business profitability. 2. Jonathan Gruber, Ian Perry - Benefits of Slower Health Care Cost Growth for Massachusetts Employees and Employers. Blue Cross Blue Shield Foundation Report April 2012

12 Comprehensive Health Care System Reform Access Uninsured Financial barriers to care Costs High and growing costs Volume driven Fee-for-service HIT Spotty implementation Lack of interoperability Potential not met Systems Inconsistent Quality Errors and adverse events Misuse, overuse, and duplication Inequities in care Disorganized, poorly coordinated Not always evidenced based Emphasis on specialty care Integrated Systems Payment Reform Health Care Workforce Planning Health Resources Planning Insurance Product Redesign Malpractice Reform All insured Financial and structural barriers to access removed Value/Quality driven Costs transparent Wide adoption Interoperable Informs and transforms clinical practice Predictable outcomes Patient safety Appropriate use Disparities eliminated Coordinated, integrated care Evidenced based Patient centered primary care

13 What is necessary to achieve savings? Reorganize the delivery system coordinated and integrated delivery systems primary care as the foundation Reform the way we pay for care Value not volume Measurable outcomes that demonstrate maintenance of health Cost Containment Legislation Enabling new delivery and payment models Capping rate of overall growth for public and private sectors

14 Care integration: coordination of providers and services across the continuum of care to support the patient Level 3 Level 2 Community hospitals and other specialists, post acute care, etc. Major specialists (orthopedics, cardiology, general surgery obstetrics, etc.) Home care and other community supports Ter2ary and Quaternary Specialists and Hospitals Improved transitions across settings Improved outcomes, efficiencies, and coordination Improved management of and outcomes for complex patients Prevention and early diagnosis Improved access to care Ability to take on more risk Level 1 Primary Care Medical Home Accountable Care Organiza2on Behavioral Health Outcomes Appropriate use of tests, referrals, and ED Decreased preventable acute events 14

15 System and Payment Delivery: New payment structures will support system delivery changes and reward quality Focus on Primary Care Increase payment, support redesign of primary care delivery, and encourage primary care utilization for all populations Quality and Cost Incentive Payments Incentives for quality, improved outcomes, and performance ACO and bundled payments Integrated delivery systems can assume different risk sharing approaches, including for dual eligibles

16 Cost Containment Legislation: Improve Quality and Control Costs by Reforming Health Systems and Payments Goals of Legislation Maintain consumer access to high quality, affordable care Decrease the cost of health care for consumers and for employers, government, and other purchasers Pay providers to take care of people not for appointments, tests, and procedures; pay more for delivering efficient, high quality care Support primary care providers as the foundation of the delivery system and create integrated systems of care to provide the right services to patients in the right way, at the right time, in the right place. Providers should not be penalized for caring for sicker patients but should be held accountable for the quality of care Transparency, ensure that consumers and employers have the information they need to make informed decisions about their health care needs

17 Potential Impact of Cost Containment: Estimated Total Health Spending if Per Capita Spending Grows at Same Rate as GDP Projected Total Personal Health Expenditures in MA (billion $), Billion $ $140 $120 $100 $80 $60 $68 $68 Without Cost Control: Projected average annual growth rate of total health spending would be 6.0% $72 $71 $77 $74 $81 $78 $86 $81 $92 $84 $97 $88 $103 $91 $109 $95 $116 $99 $123 $103 Cost Control: Projected average annual growth rate of total health spending would be 4.2% based on the per capita GDP growth rate of 3.9% $40 $20 $ Sources: per capital GDP growth rate is based on national projection data. US Social Security Administration, The 2008 OASDI Trustees Report, Supplemental Single-Year Tables, intermediate projection, Per capita GDP index: real GDP annual change + GDP price index annual change population annual change. U.S. Census Bureau, Population Division, Interim State Population Projections, 2005.

18 Health Information Technology HIT related (HIT) Initiatives: MA IT Initiatives Integral to achieving efficient and high quality health Summary care of Features HIE Certified EHR HIX/IES APCD The development of the state-wide Health Information Exchange will enable the secure and timely electronic exchange of authorized health information to citizens, providers, and public health agencies. Providing incentives and other services that support widespread adoption and meaningful use of federally Certified Electronic Health Record Technology by providers and citizens Health Insurance Exchange/Integrated Eligibility System to support eligibility and enrollment in health and human services and facilitating effective data sharing among programs The All Payer Claims Database has been developed to support providing access to timely and accurate claims and eligibility data from Medicaid, Medicare, fully insured and self-insured payers. Data collection, exchange, and analytics 18

19 HIE: Several communities have begun working together for purposes of exchanging health information VITL NH- HIO North Adams Newburyport NYeC Berkshire Health Holyoke Emerson Winchester Beverly Baystate SafeHealth NEHEN South Shore Sturdy RIQI Cape Cod Health

20 Certified EHR: $101.3M in incentive payments have been paid to encourage EHR adoption and meaningful use Since the program launched in October 2011, Massachusetts has disbursed Program Year 2011 $38.5 million in Medicaid incentives to 1,847 eligible professionals $41.0 million in Medicaid incentives to 42 to eligible hospitals Program Year 2012 $14.2 million in Medicaid incentives to 695 eligible professionals $7.6 million in Medicaid incentives to 12 eligible hospitals The Office of Medicaid estimates that Massachusetts will disburse over $600 million in Medicaid incentives over the life of the program which runs through 2021.

21 HIX/IES: The two-phased project will focus on connecting customers with health care and other assistance programs Integrated Portals Integrated Eligibility System Phase I: Jan Health and Human Services Health Portal Insurance Exchange Portal HIX will allow consumers to shop for health insurance, apply for financial assistance, and enroll in private and public plans in real-time. IES will determine eligibility for the Medicaid and CHIP programs - either directly or by talking to MA21 in real time. It will also determine eligibility for SHOP employers and employees, and more. Phase II: 2015 Other EOHHS Programs Portal HIX will allow consumers to apply for other public assistance programs such as SNAP and TANF. The IES will determine eligibility for these programs. Result A first-class, 21 st century customer and provider experience that is consumer-focused, cost-effective, and re-usable by other states.

22 Phase 1 HIE and APCD: Phased approach which begins with creating the infrastructure Information Highway Create infrastructure to enable secure transmission ( directed exchange ) of clinical information Will support exchange among clinicians, public health, and stand-alone registries Focus on breadth over depth Phase 2 Facilitate normalization and aggregation Analytics and Population Health Create infrastructure to facilitate data aggregation/analysis Will support Medicaid CDR and quality measure infrastructure Will support vocabulary translation services (lab, RX) Enable queries for records Phase 3 Search and Retrieve Create infrastructure for cross-institutional queries for and retrieval of patient records

23 Uncertainty Sustainability Winners and losers ACA and impact of Supreme Court ruling Persistence and growth of public cynicism