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Integrating Medicare and Medicaid: Some History and Where We’re Going Ohio HFMA Winter Seminar – Friday, December 12, 2014 Moderator: Jenny Sand, Home.

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Presentation on theme: "Integrating Medicare and Medicaid: Some History and Where We’re Going Ohio HFMA Winter Seminar – Friday, December 12, 2014 Moderator: Jenny Sand, Home."— Presentation transcript:

1 Integrating Medicare and Medicaid: Some History and Where We’re Going Ohio HFMA Winter Seminar – Friday, December 12, 2014 Moderator: Jenny Sand, Home Care by Black Stone Panel:Michael Cebellos, Buckeye Health Plan Jan Reed, Molina Healthcare Jana Snyder – Provider Services, Molina Healthcare Deb Jacobs – Health Care Services, Molina Healthcare Elbony McIntyre – Ohio Department of Medicaid

2 High-Level History 1965 – Medicare & Medicaid created 1970’s – HMOs offer Medicare 2003 – MMA and Part D 2013 – Medicare- Medicaid Plan demonstrations Medicare-Medicaid plans are the first major attempt to modify the existing system since inception. 2

3 Duals Enrollment & Spending Current spending is unsustainable – change is here to stay. Let’s make MyCare Ohio the best it can be. 3

4 Health Care System Choices 4

5 Demonstration States 5

6 The Opportunity  Ohio was the third state to go-live with the demonstration, and the only to begin with Medicaid passive enrollment.  82 various metrics captured and evaluated by CMS.  What success looks like to be determined through the various state-based demonstration.  We are five months into a 42-month demonstration.  We are creating the future, together. 6

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8 MyCare: Ohio’s Medicare/Medicaid Plan  The Demonstration coordinates the physical, behavioral, and long- term care services for individuals over the age of 18 who are eligible for both Medicaid and Medicare. This includes people with disabilities, older adults and individuals who receive behavioral health services  The 42-Month Demonstration, went live in the Northeast region on May 1, July 1, 2014 saw the last regions go-live.  Of the roughly 182,000 Ohioans covered by both Medicare and Medicaid, as many as 114,000 individuals are expected to be served through the demonstration.  MyCare Ohio enrollees, all of which have Medicaid, will be passively enrolled into Medicare on January 1, 2015; unless a member has chosen to opt-out. 8

9 Mission The demonstration is a fully capitated program that creates organized systems of care that provide comprehensive services to Medicare-Medicaid enrollees. MyCare Ohio integrates and coordinates healthcare delivery by:  Utilizing managed care to improve care coordination that is patient-centered  Providing one point of contact for beneficiaries  Emphasizing individual choice and control in care delivery  Providing coordination of long-term care services, behavioral health services and physical health services  Supporting an individual’s right to live independently  Reducing the overall cost of care for the beneficiary, Medicaid and Medicare  Providing a seamless transition between settings and programs. 9

10 Complexity to Simplicity 10 MyCare Ohio Medicaid Behavioral Health Long-Term Supports & Services Medicare Part A & B Medicare Part D Model of Care – one point of entry into a complex, priority competing system

11 Model of Care 11

12 Model of Care 12 One point of entry into complicated system Trans-disciplinary team facilitator Accountable Point of Contact Every member conducts a bio-psycho-social assessments Integrated care plan and goals Assessment and Care Plan Care Manager meet with member in-patient Trans-disciplinary team executes discharge plan Care Transitions Medicare, Medicaid and assessment information to stratify members into appropriate clinical programs Clinical Programs

13 Implementation Timeline  January 1, 2015 – Medicare passive enrollment  December 31, 2017 – Demonstration ends

14 Regions Region Managed Care Plans Northwest Aetna Buckeye Southwest Aetna Molina West Central Buckeye Molina Central Aetna Molina East Central CareSource UHC Northeast Central CareSource UHC Northeast Buckeye CareSource UHC 9,884 16,225 12,381 6,029 19,456 9,284 37,712

15 Panel Questions & Answers


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