1. A Plan to Transform the Empire State’s Medicaid Program 2013 Ten State Regional Conference February 23, 2013 Jason A. Helgerson, Medicaid Director NYS Department of Health Redesign Medicaid in New York State

2. Overview 1) Medicaid Redesign Team (MRT) A Quick Recap 2) MRT Multi-Year Action Plan Achieving the CMS Triple Aim 3) Key Initiatives 4) Results 5) Next Steps Redesign Medicaid in New York State 2

3. THE MRT WORKED IN TWO PHASES o This is the first effort of its kind in New York State. o By soliciting public input and bringing affected stakeholders together, this process has resulted in a collaboration which reduces costs while focusing on improving quality and reforming New York’s Medicaid system. Phase 1: Provided a blueprint for lowering Medicaid spending in state fiscal year 2011-12 by $2.2 billion. Phase 2: Developed a comprehensive multi- year action plan to fundamentally reform the Medicaid program. Redesign Medicaid in New York State 3 MRT Recap

4. MRT Phase I Overview o MRT Phase 1 recommendations provided a blueprint for lowering Medicaid spending in state fiscal year 2011-12 by $2.2 billion. Phase 1 completed February 24, 2011. Initial MRT report met the Governor's Medicaid spending target contained in his 2011-2012 budget.  79 recommendations were included in MRT report and 78 recommendations were approved by the legislature as part of the budget and are currently being implemented. o The plan allowed NYS to move from an environment where growth in the Medicaid program was anticipated to rise by 13% (state share), and ensured growth would rise by 1% (state share). Redesign Medicaid in New York State 4

5. MRT Phase II Overview o The MRT continued its innovative work in a second phase: MRT broke into 10 work groups to address more complex issues. MRT monitored the implementation of key recommendations enacted in Phase 1. MRT Phase 2 completed on December 13, 2011. Redesign Medicaid in New York State 5

6. MRT Phase II Overview Redesign Medicaid in New York State 6 o MRT work groups gave an additional 175 stakeholders the opportunity to participate in the MRT process: All work group meetings were public. Each work group produced a final report of recommendations. All work group reports were approved by the MRT. Recommendations from Phase 1 & Phase II combined into a single, multi-year Medicaid reform strategy.

7. Final Product o Most sweeping Medicaid reform plan in state history. o Pulls together the work of the MRT into a single action plan. o Plan is closely tied to successful implementation of the federal Affordable Care Act (ACA). o The plan also embraces the CMS “triple aim” of: Improving care, improving health, and reducing costs. Redesign Medicaid in New York State 7

8. Key MRT Initiatives o Medicaid Global Spending Cap Multi-year spending cap with growth linked to CPI-Medical. Introduced fiscal discipline and transparency. New York is actually managing its Medicaid program on a daily basis. o Universal Access to High Quality Primary Care GOAL – All Medicaid members access primary care from nationally accredited Patient Centered Medical Homes. New York invested in this effort - $100 million per year. Redesign Medicaid in New York State 8

9. Key MRT Initiatives o Care Management for All End the inefficient FFS Medicaid program that distorts incentives in health care delivery. Multi-year phase in. Contract with around 50 fully integrated health plans statewide. Capitation is not enough – Provider level payment reform will also be required (shared savings, sub- capitation, shared savings, etc.) Redesign Medicaid in New York State 9

10. Key MRT Initiatives o Health Homes New York is creating “Accountable Care Organizations” for the state’s highest needs patients. Health Homes are integrated provider networks (including housing and human service providers) that work together, share information in real time and help coordinate care for the population that drives Medicaid spending. The goal with Health Homes – transform health care delivery into to a true “team sport” starting with our most complex patients. Redesign Medicaid in New York State 10

11. Key MRT Initiatives o Other Initiatives First state in the nation to redirect Medicaid savings to expand access to supportive housing for high needs Medicaid patients. Integration of behavioral health with physical health at both the plan and provider levels. Complete transformation of FFS reimbursement in long term care in preparation for managed care. Investing in innovative public health strategies and program wide acceptance that Medicaid must be a force for addressing population health problems. Redesign Medicaid in New York State 11

12. MRT Results o Spending down 9% on a per recipient basis. o Lowered Medicaid spending by over $4 billion on an annual basis. o In Year 1, generated enough savings for the federal government to “flat-line” the national growth rate in Medicaid. o Increased the number of Medicaid members using PCMH’s by one million. Redesign Medicaid in New York State 12

13. MRT Results o Launched 34 health homes statewide. 16,000 high needs patients enrolled. o Invested $75 million in supportive housing and the first units of “MRT Housing” are now open in the Bronx. o Generated statewide consensus on how to fundamentally reform New York’s Medicaid program. Redesign Medicaid in New York State 13

14. o Thanks to the MRT we now have a multi-year action plan, a roadmap, for meaningful Medicaid reform. o Need to get the MRT waiver amendment approved. o Need to continue to implement MRT action plan. o Biggest risks are continued enrollment growth and potential federal cuts in Medicaid/Medicare. Next Steps Redesign Medicaid in New York State 14

15. Contact Information We want to hear from you! ‘ Like’ the MRT on Facebook: http://www.facebook.com/NewYorkMRT Follow the MRT on Twitter: @NewYorkMRT Subscribe to our listserve: http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm MRT Waiver e-mail: mrtwaiver@health.state.ny.us Redesign Medicaid in New York State 15