Transcript Minnesota’s Approach: Integrated Medicare & Medicaid Programs Alliance for Health Reform Briefing on Dual Eligibles June 3, 2011 Scott Leitz Assistant Commissioner for Health Care Minnesota Department of.

Minnesota’s Approach:
Integrated Medicare &
Medicaid Programs
Alliance for Health Reform
Briefing on Dual Eligibles
June 3, 2011
Scott Leitz
Assistant Commissioner for Health Care
Minnesota Department of Human Services
MN’s Dually Eligible Population
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106,600 Minnesotans are fully eligible for both Medicare
and Medicaid
97% of seniors and 50% of people with disabilities on
Medicaid are dually eligible
About 40% of MN’s total Medicaid spending is for duals
68% of seniors and 41% of people with disabilities in
MN Medicaid receive long-term care services
Most seniors served through managed care
 Minnesota SeniorCare Plus (MSC+)
 Minnesota Senior Health Options (MSHO): SNP
program, voluntary alternative to MSC+
Most people with disabilities served through FFS
 Special Needs BasicCare (SNBC): SNP program,
voluntary alternative to FFS
Key Service Needs of Duals
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Aligned financial incentives between payers
(Medicare and Medicaid) and providers
Primary and chronic care management strategies
implemented across care settings
Improved coordination between primary, acute and
long-term care services
Aligned networks across Medicare and Medicaid
providers
Navigation assistance to get to right providers at
the right time
Simplified paperwork and member materials that
explain Medicare and Medicaid services and how
they fit together
Coordination with behavioral and housing needs
Distinct Population Issues
For seniors:
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Many opportunities for reducing hospitalization but
savings accrue to Medicare
Diversion strategies from nursing homes and high
costs community settings (assisted living)
For people with disabilities:
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High use of specialty care but lack of access to
basic primary and preventive care
Many primary care providers unwilling or lack
expertise to serve people with disabilities
Majority have co-occurring mental health diagnoses
Not a static population: people with disabilities
constantly becoming dual after Medicare waiting
period results in continuity of care issues
Primary Issues Facing States
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Medicare-paid providers drive primary and acute
care. If poorly managed, Medicaid pays for the result
(Higher need for long-term care services)
Increased pressure on State budgets due to high
growth in dual eligible populations; need to prepare
for both fiscal and care delivery challenges
Lack of financial equity for States for investment in
aligned/integrated options (immediate savings
accrue to Medicare)
Lack of stable scale-able platforms for alignment of
Medicaid and Medicare for the future
Access to Medicare data for total cost of care
requires State resource investment
Minnesota’s Approach
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First state to integrate Medicare and Medicaid
primary, acute and long-term care for seniors
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Transitioned from Medicare demo to SNP status in
2005
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No complex waivers needed; we use existing state
plan and home and community based service
authorities under 1915 (a) and (c ).
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Close working relationship and ongoing
understanding and support from CMS (both
Medicare and Medicaid) have been very important
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Stakeholder involvement key in acceptance of
managed care approach for people with disabilities
Where We’ve Succeeded
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SNPs aligned with State long-term care goals for
improved access and cost management
Majority of seniors now served in community
98% of seniors on MSHO now receive annual
primary/preventive care visits
State has leveraged integrated Medicare data and
coverage of additional care coordination through
contracts with Medicare SNPs
Continued enrollment growth in current integrated
program for people with disabilities (SNBC)
despite loss of some SNPs
Creative environment has produced some total
cost of care models (virtual) that manage across
payers and domains of care
Not Without Challenges
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Limited opportunity for State to share any
Medicare and Medicare SNP savings under
current models
SNP bid process has resulted in premiums that
duals cannot pay and thus lack of stability in SNP
participation in integrated programs
Need to stabilize current SNP platform for
integration and make it more attractive to States
Need for improvement in Medicare risk
adjustment for frail seniors and people with
disabilities
Integration of administrative processes: devil is in
details, requires expertise and diligence
Moving Forward
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Working to bring up PACE in Minnesota
Implementing statewide All Payer Health Care Home
including CMS Medicare APC demo
Care Delivery System Payment Demo RFP will be
issued soon; future steps expected to include FFS
and MCO duals
Duals Demonstration Planning Contract with CMS
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Development of performance metrics, risk adjustment, total
cost of care payment models and provider feedback
mechanisms specific to dual eligibles, consistent across
managed care and FFS
Pursuing improvements in current SNP and/or new
platforms for integrated financing and service delivery
Contact Information
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Scott Leitz
Assistant Commissioner for Health Care
Minnesota Department of Human Services
[email protected]
(651) 431-2012
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Pam Parker
Special Needs Purchasing
Minnesota Department of Human Services
[email protected]
(651) 431-2512
Seniors
MSHO (Statewide)
MSC+ (Statewide)
1915 (a)(c)
1915(b)(c )
Enrollment 65+ Voluntary 37,000 (5/11)
Mandatory 11,500
Medicare
Services
Medicare A/B services through
Medicare FFS.
Part D drugs through separate
Medicare drug plan
All Medicare services
including Part D drugs
through Medicare Special
Needs Plan (SNP)
Medicaid Basic Medicaid state plan
Care Services
services (includes PCA)
and remaining drugs
through same SNP
(5/11)
Medicaid only plan provides
state plan (includes PCA) and
remaining drugs
Medicaid Long- Elderly Waiver (EW)
EW through same plan plus
Term Care
through SNP plus 180
180 days of nursing home
Services
days of nursing home care care
People with Disabilities
Fee For Service
(46,600
enrollees)
Enrollment
Age 18-64
Medicare
Services
Special NeedsBasicCare (Managed Care)
(6,000 enrollees)
Authority: 1915(a)
Voluntary, open to both duals and non duals with
disabilities in 78 counties (new legislation pending
to expand with opt out enrollment process)
Medicare A/B
through FFS
Separate Part D
Plan enrollment
All Medicare services including Part D drugs
through 4 Medicare Advantage SNPs,
One SNBC MCO does not offer SNP
Medicaid
Basic Care
Services
Most Medicaid state plan services provided
through same SNP plan including remaining
drugs except PCA and PDN which remain Fee for
Service, provides platform for integration of all
behavioral services including MH-TCM.
Medicaid
Long-Term
Care
Services
Includes first 100 days of nursing home care and
remaining home health care, Medicaid HCBS
waivers and long term care services remain Fee
for Service