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Aetna Medicaid Aetna Medicaid Overview Long Term Services and Supports August 2013.

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Presentation on theme: "Aetna Medicaid Aetna Medicaid Overview Long Term Services and Supports August 2013."— Presentation transcript:

1 Aetna Medicaid Aetna Medicaid Overview Long Term Services and Supports August 2013

2 Aetna Medicaid Medicaid Overview  Core business is serving TANF/ CHIP/ ABD/LTSS with a focus on serving high acuity populations  Post Coventry acquisition we have grown to ~2.2 million members across 16 states  Recent awards validate the strength of our integrated care expertise and ability to effectively manage high acuity populations  Duals programs in Ohio, Illinois and New York  LTSS programs in Illinois, Delaware and New York  Behavioral Health/SMI award in Arizona Aetna and Coventry Existing Medicaid Markets Populations Served  TANF: Temporary Assistance for Needy Families  CHIP: Children’s Health Insurance Program  ABD: Aged Blind Disabled  LTSS: Long Term Services and Supports  Duals: Members eligible for both Medicaid and Medicare  BH/ SMI: Behavioral Health/ Seriously Mentally Ill (Recently awarded Arizona contract) 2 Aetna is a leader in managing medically complex populations at the local, community-based level by integrating physical health, behavioral health and social economic status of members Aetna States Coventry States Shared States

3 Aetna Medicaid Introducing a Key Issue… 3

4 Aetna Medicaid Aetna Medicaid Model of Care and Capabilities 4

5 Aetna Medicaid Aetna’s Model of Care - Integrated Care Management 5 Received “recognized” 96.4% of 100% score Focuses on members with a lower complexity profile with less risk for future utilization but with an immediate presenting issue low risk profiled members and specific contractually- required populations RISK High Low Low Intensive Care Management Standard Care Management Service Coordination & Support Population Health Services Member centered approach & focus on community relationships integrating physical health, behavioral health and social economic status of members Focuses on high-risk vulnerable members characterized by bio-psycho- social complexity. Care managers address the root causes that drive poor health, within the context of a longer term working relationship with the member

6 Aetna Medicaid Goal: Decrease Fragmentation and Improve Coordination of Care Working with Members  All members assigned to CM, member centered approach  CM assess members in multiple settings including home, assisted living facility and nursing facilities -- helps drive quality  Responsible for managing entire member through integration and coordination of care Medical: Hospital Discharge, PCP Visits, DME, Pharmacy Functional: In-home Care, Assisted Living, Nursing Facility Behavioral Health: Full array of BH services carved in  Special Care Management teams for behavioral health and medically complex recipients  Drive member action – vaccinations, PCP visits 6

7 Aetna Medicaid Local Integrated Support of Members in their Community 7

8 Aetna Medicaid Effective Use of Home and Community Based Care ALTCS Trend HCBS Utilization Governor’s Report to Senate Percentages % 8

9 Aetna Medicaid Medicaid LTSS Users Accounted for Nearly Half of Medicaid Spending, 2010 NOTE: Individuals who used both institutional and community-based services in the same year are classified as using institutional services in this figure. SOURCE: KCMU and Urban Institute estimates based on data from FY 2010 Medicaid Statistical Information System (MSIS). Because 2010 data was unavailable, 2009 data was used for Colorado, Idaho, Missouri, and West Virginia. 9

10 Aetna Medicaid Capitated Medicaid Managed LTSS: An Emerging Trend 10 CMS reports that more than half the states are expected to be operating capitated Medicaid managed LTSS programs by January 2014, including:  Expansion of current Medicaid capitated managed LTSS programs under § 1115 or § 1915(b)/(c) 19 states with waivers implemented or approved as of 2012 (AZ, CA, DE, FL, HI, KS, MA, MI, MN, NH, NJ, NM, NY, NC, PA, TN, TX, WA, and WI)  Establishment of new Medicaid capitated managed LTSS programs under § 1115 or § 1915(b)/(c) 3 states with proposals pending (CA, IL, and NV)  Implementation of Medicare/Medicaid financial alignment demonstrations for dual eligible beneficiaries under § 1115A combined with § 1115 or § 1915(b)/(c) 5 states with capitated proposals approved (CA, IL, MA, OH, and VA); 10 states with capitated proposals pending (HI, ID, MI, NY, OK, RI, SC, TX, VT, and WA) SOURCES: P. Saucier, J. Kasten, B. Burwell, and L. Gold, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012, available at: M. Musumeci, Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: California, Illinois, Massachusetts, Ohio, and Washington, The Henry J. Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, May 2013, available at ohio-and-washington-financial-alignment-demonstrations-for-dual-eligible-beneficiaries-compared/.

11 Aetna Medicaid The New Health Care Landscape is Emerging… New and Innovative Relationships  Increased focus on innovative care management models for high-risk populations across the community care continuum Value-Based Payment Models  Demand for value-based purchasing arrangements focused on achieving quality outcomes: pay for performance, shared savings, bundled payments, alignment of quality incentives Health Information Technology Alignment  Intense focus on health information technology as key driver for care coordination and point-of-care delivery optimization 11

12 Aetna Medicaid Home Care or Nursi ng Facil ity Care Coordination of the Future Care Coord inato r 12

13 Aetna Medicaid Aetna Solutions: The Role of Technology  Clinical Data Integration  Secure Data Exchange  Real time provider interface  Application Store  Rapid Distribution  Population based clinical intelligence  Decision support  Care management  Popular mobile based application  User (symptom) to provider link  Appointments, registration, alerts, cost Health Information Technology Alignment - focus on health information technology as key driver for care coordination and point-of-care delivery optimization 13

14 Aetna Medicaid A Partnership for the Future…  An Integrated System  The Right Experience  The Right Perspective  The Right Technology  The Right Results High Quality High Satisfaction Aligned Stakeholders Future Focused Cost Savings Thank You! 14


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