Presentation on theme: "Orientation to DCH Navigant Report"— Presentation transcript:
1 Orientation to DCH Navigant Report Wendy White Tiegreen, M.S.W.Deputy Chief of StaffDepartment of Behavioral Health & Developmental Disabilities
2 DCH Medicaid Redesign Initiative Georgia Department of Community Health (DCH)=State Medicaid AuthoritySummer to Fall 2011: comprehensive assessment and recommended redesign of Georgia's Medicaid Program and Children's Health Insurance Program (CHIP/PeachCare for Kids®)Navigant Consulting retained to conduct this review. Goal: “to help us look at various strategic options geared toward achieving long-term program and financial sustainability.” (http://dch.georgia.gov/00/channel_title/0,2094, _ ,00.html)
3 DCH Medicaid Redesign Initiative: DBHDD Behavioral Health Context:DBHDD is the policy manager, definition designer, provider network manager, utilization review organization, co-funder for DCH/Medicaid.In other words, DBHDD=Managed Care Organization for DCH for the following populations:Aged, Blind, Disabled (Adults and Youth)Foster Care YouthManaged Care Covered (CMOs) in the “Gap”Over 50,000 “covered lives”~32,000 Adults~20,000 Youth
4 DCH Medicaid Redesign Initiative: DBHDD DBHDD is Partnered with DCH on Leveraging Federal Funds:Legislative Appropriation to DBHDDLeveraged through DCH from CMS
5 DCH Medicaid Redesign Initiative: Reform Context Medicaid Expansion (2014):Millions of low-income adults without childrenMany low-income parentsSome children now covered through the Children’s Health Insurance Program (CHIP)People who already are eligible for Medicaid under current rules but have not enrolled.In total, Medicaid/CHIP, is expected to cover an additional 16 million people bySOURCE: Kaiser Family Foundation
6 DCH Medicaid Redesign Initiative: Reform Context + CMO Contracts already extended, redesign called forContinued growth in Medicaid:DCH forecasted the need for $120.4 million for projected enrollment growth in FY 2013 (gpbi.org)Since the recession began in 2008, total enrollment in Medicaid and PeachCare has increased by more than 200,000 individuals, about 14 percent (DCH, January 2012)
7 Navigant Recommendations Medicaid and PeachCare for Kids® Design Strategy ReportEXECUTIVE SUMMARY, January 23, 2012DCH should become a “value‐based purchaser” by:Increasing communication among all stakeholdersReducing administrative complexities and burdens for providers and membersStandardizing, centralizing or streamlining appropriate processes and forms across the CMOsIncreasing patient compliance through incentives and disincentivesIncreasing focus on health and wellness programs and preventive medicineOther opportunities for improvement include:• Tracking progress over time in achieving quality of care improvements using the(Healthcare Effectiveness Data and Information Set) HEDIS® and HEDIS®‐like measures• Considering an approach to manage care for Georgia’s most expensive Medicaid members: those who are dually eligible and those who are aged, blind and disabled• Considering short‐ and long‐term plans for the use of technology including electronic health records and telemedicine
8 Navigant Recommendations Narrowed Overall Options to 3:Option 6: Georgia Families Plus;Option 8: “Commercial Style” Managed Care; andOption 9: Free Market Health Insurance Purchasing.Additional Recommendations for Specific Target Populations
9 Navigant Recommendations Option 6: Georgia Families Plus; (GA Families=Current CMO Model)Expands upon the current Georgia Families program by:• Incorporating extensive value‐based purchasing• Further encouraging use of medical homes, for example, through PCMHs• Reducing administrative complexities and burdens for providers and members• Increasing patient compliance through incentives and disincentives beyond those currently used in Georgia Families• Increasing focus on health and wellness programs and preventive medicine• Continuing to build upon current efforts to focus on quality• Carving in more services (e.g., transportation) and populations (e.g., dual eligibles)
10 Navigant Recommendations Option 8: “Commercial Style” Managed CareExpands upon Option 6, Georgia Families Plus program, a full risk‐based managed care program with value‐based purchasing:• Employs all levers and innovations typically used in commercial market, including incentives and, for some members, deductibles and copayments, to encourage members to be activeparticipants in their health care and to comply with treatment plans• Establishes HRAs for members where rewards (e.g., incentive payments) are deposited formembers who meet goals for healthy behaviors to purchase preapproved health care‐relatedservices or items• Balances in HRAs could be used in a shared savings model whereby members, upon leavingMedicaid or reaching the end of the benefit year, have the option to spend a portion ofremaining funds on pre‐approved items such as health club memberships
11 Navigant Recommendations Option 9: Free Market Health Insurance Purchasing• DCH would provide a credit to members for purchase of insurance through the free market• DCH would not contract directly with health plans and would not process claims• DCH would partner with the Department of Insurance to define the standard Medicaid benefit packages participating health plans must offer and certification requirements specific to Medicaid (e.g., covered benefits, provider network composition and reporting)• DCH would contract with or serve as a choice counselor, helping members to select a healthplan
13 Navigant Recommendations Behavioral Health Options (Navigant Report, Appendix L):Carve in behavioral health services. In this risk‐based managed care deliveryCarve out services to be managed by a different vendor or community vendors.Carve out population with physical health to also be managed by behavioral health providers.
14 Navigant Recommendations Carve in behavioral health services.Navigant: In this risk‐based managed care delivery system, behavioral health services would be included in the benefit package, along with physical health services, and the cost of the benefit would be included in the capitation rate, similar to the current model for Georgia Families. The health plan would be responsible for managing the behavioral health benefit for its enrolled population, either through a subcapitated arrangement or by developing its own behavioral health provider network, payment rates and policies governing the behavioral health benefit.
15 Navigant Recommendations Carve in behavioral health services, in other words:Integration is an omnibus concept, defined in many ways. There can be financial, structural and/or clinical practice integration. Integration that is financial (benefit packages, “carve-ins”, shared risk pools or other incentives) or structural (services delivered under the umbrella of the same organization, BH specialty services co-located with primary care services) does not necessarily assure clinical integration. (NCCBH, Mauer 2006)
16 Navigant Recommendations Physical HealthBehavioral Health
17 Navigant Recommendations Faux Carve-InsPhysical HealthBehavioral Health
18 Navigant Recommendations Carve out services to be managed by a different vendor or community vendors.In this risk‐based managed care delivery system, behavioral health services would be carved out to a different vendor specifically focused on managing behavioral health services. The vendor would be responsible for managing the behavioral health benefit for the same population managed through the physical health plan and developing its own behavioral health provider network, payment rates and policies governing the behavioral health benefit.
20 Navigant Recommendations Carve out population with physical health to also be managed by behavioral health providers.In this model, individuals with specific behavioral health diagnoses would be carved out of the physical health delivery system. Their full needs, both physical health and behavioral health, would be managed and coordinated by behavioral health care providers.NOTE: Not mutually exclusive to other two options!
21 DCH Plan Feedback Due to DCH by February 29, 2012 (Next Week) _ ,00.html2 Modes for Feedback:Detail feedback submitted through “Feedback Tool” (500 Character Limit)Brief Comment (no attachments) through:
22 DCH Plan Assessment – Completed Recommendation – Underway August – December 2011, completed.Recommendation – UnderwayJanuary 2012, posting of Strategy Report.January – April 2012, review and analysis of the Strategy Report.April 2012 – Finalization of the Redesign Model.Procurement – Later in 2012, 2013April – July/August 2012, procurement planning.July/August 2012, procurement documents to be posted.January 2013, contract award to successful vendor(s).Implementation – Planned for Early 2014January/February 2014, implementation begins.