Medicaid Innovation: Payment Reform

Transcription

1 Medicaid Innvatin: Payment Refrm CSG West: Finance and Ecnmic Develpment Aug. 17, 2017 Lindsey Brwning Prgram Directr

2 Overview Backgrund & cntext Medicaid payment refrm Key mdels Challenges Opprtunities Takeaways fr western state legislatrs Natinal Assciatin f Medicaid Directrs 2

3 Backgrund & Cntext Natinal Assciatin f Medicaid Directrs 3

4 Natinal Assciatin f Medicaid Directrs Bi-partisan, standalne assciatin Represent 56 Medicaid directrs, including DC and territries Our missin is t Be the cnsensus vice f state Medicaid Directrs in federal plicy prcess Supprt sharing f best practices arund key state pririties Natinal Assciatin f Medicaid Directrs 4

5 Medicaid s Structure Federal/state partnership Jintly financed by states and federal gvernment Operated by states under brad federal rules Delivers cmprehensive care fr 74 millin Americans Respnsible fr nearly 30% f state budgets Surce: Medicaid and CHIP Payment and Access Cmmissin, Distributin f Medicaid, Educatin, and All Other Spending frm Ttal State Budgets versus State-Funded State Budgets, SFY 2015 Natinal Assciatin f Medicaid Directrs 5

6 Medicaid s Rle in States & Cmmunities Cmprehensive health care fr 74 millin Americans Helps wrking families ut f pverty Keeps peple as independent & healthy as pssible Essential in battling piid crisis Reduces the burden f uncmpensated care n hspitals & prviders Efficient & cst effective Primary payer fr lng-term services and supprts fr senirs & peple with disabilities 6

7 Medicaid Payment Refrm Natinal Assciatin f Medicaid Directrs 7

8 Key Areas f Innvatin Leveraging public-private partnership f risk-based managed care Behaviral health integratin Re-balancing lng-term services and supprts Payment refrm (fcus fr tday) 8

9 Why payment refrm? Rapid grwth f health care csts in U.S. Fee-fr-service payment at prvider level = fragmented, uncrdinated care Medicaid respnsible fr mst cmplex and cstly ppulatins Payment refrm uses Medicaid s purchasing pwer t drive crdinated health care & cntain cst grwth It s nt an end, but a means t transfrming care delivery 9

10 Medicaid Payment Refrm Study NAMD/Bailit Health reprt n Medicaid alternative payment mdels (2016) Develped in partnership with The Cmmnwealth Fund Mixed methds apprach Findings frm 34 states and sample f 5 Medicaid MCOs Alternative Payment Mdels (APMs): a mdel that links prvider payment t perfrmance n quality and cst. Natinal Assciatin f Medicaid Directrs 10

11 Overarching Findings Payment refrm happening natinally in Medicaid Hw alternative payment mdels are being implemented varies by state Occurring thrugh MCOs and direct cntracting with prviders Initial fcus n primary and acute care; sme states beginning t fcus n lng-term care and behaviral health States with State Innvatin Mdel (SIM) grants and Delivery System Refrm Incentive Payment (DSRIP) Prgrams tend t be further alng 11

12 Alternative Payment Mdels in a Fee-fr- Service Delivery System State Prviders Alternative payment mdels in this system are changing the way the state pays prviders 12

13 Alternative Payment Mdels in a Managed Care Delivery System State Managed Care Organizatins Prviders Alternative payment mdels in this delivery system are changing way MCOs pay their prviders 13

14 Alternative Payment Mdels in Managed Care Many states require r encurage MCOs t increase use f alternative payment mdels State appraches in managed care mdels vary: Prmte use f alternative payment mdels by MCOs Medicaid agency prvides financial incentives fr MCOs t use alternative payment mdels Cntractually require MCOs t implement MCO-defined alternative payment mdels Medicaid agency designs an alternative payment mdel and cntractually requires MCOs t implement it Natinal Assciatin f Medicaid Directrs 14

15 Mst Cmmn Medicaid Alternative Payment Mdels Additinal Payments in Supprt f Delivery System Refrm Per member per mnth n tp f fee-fr-service payments fr care management/practice transfrmatin Often supprts patient-centered medical hmes and/r Health Hmes Examples: Vermnt, Idah Episde-based Payments Prvider financially accuntable fr a defined and discrete set f services ver limited time (the quarterback ) Examples: Arkansas, Tennessee, Ohi Ppulatin-based Payments Prviders respnsible fr a cmprehensive set f services fr a patient ppulatin Ptential t share in savings/risk based n actual csts & quality Examples: Oregn, Minnesta 15

16 Challenges & Opprtunities in Medicaid Payment Refrm Natinal Assciatin f Medicaid Directrs 16

17 Challenges Cmplexity PPS fr Safety-net Prviders Data Sharing State Operatinal Capacity Quality Alignment Prvider Readiness Natinal Assciatin f Medicaid Directrs 17

18 Opprtunities Multi-payer Alignment Lng-term Services and Supprts Scial Determinants Behaviral Health Integratin Natinal Assciatin f Medicaid Directrs 18

19 Takeaways fr Western State Legislatrs Natinal Assciatin f Medicaid Directrs 19

20 Takeaways fr Western State Legislatrs Medicaid Directrs are driving payment refrm t reduce fragmentatin, imprve quality & cntain cst grwth Medicaid innvatins, especially alternative payment mdels, require significant state investment Will take time t evaluate new payment mdels, but early evidence is prmising Multi-payer alignment is challenging, but increasingly imprtant pprtunity Natinal Assciatin f Medicaid Directrs 20

21 Questins? Lindsey Brwning Prgram Directr Natinal Assciatin f Medicaid Directrs Lindsey.brwning@medicaiddirectrs.rg Natinal Assciatin f Medicaid Directrs 21