1. Vermont’s Dual Eligible project National Academy for State Health Policy’s 23 rd Annual State Health Policy Conference Brendan Hogan Vermont10/5/10

2. Overview Vermont Population Context Global Commitment 1115 waiver Choices for Care 1115 LTC waiver Governor’s Blueprint for Health Current project – VT as Medicare Plan 2

3. VT Population context Total state population – estimated 600,000 Total Medicare population – est. 98,000 Total Medicaid & RX population – est. 150,000 Total Dual Eligible population – est. 15,000 3

4. Global Commitment 1115 waiver Vermont has a first in the nation Global Commitment 1115 Medicaid waiver Waiver includes all Medicaid services except SCHIP and LTC http://ovha.vermont.gov/administration/200 8-global-commitment-to-health-documentshttp://ovha.vermont.gov/administration/200 8-global-commitment-to-health-documents 4

5. Choices for Care 1115 LTC waiver Vermont has a first in the nation 1115 LTC waiver where VT allows a choice of nursing home or home and community based services for LTC Medicaid eligibles http://www.ddas.vermont.gov/ddas- programs/programs-cfc/programs-cfc- default-pagehttp://www.ddas.vermont.gov/ddas- programs/programs-cfc/programs-cfc- default-page 5

6. Governor’s Blueprint for Health Governor Douglas created the Blueprint for Health in Vermont and charged the Vermont Dept of Health to carry out this chronic care management initiative which now involves multi-payer funded pilots in several VT communities http://healthvermont.gov/blueprint.aspx Governor Douglas created the Blueprint for Health in Vermont and charged the Vermont Dept of Health to carry out this chronic care management initiative which now involves multi-payer funded pilots in several VT communities http://healthvermont.gov/blueprint.aspx 6

7. Vermont is a Medicare plan VT would work with CMS on authority to act as a Medicare plan Medicaid authority would remain with our two 1115 waivers. Duals are in both 1115 waivers Financial, data, legal and programmatic analyses are occurring right now for this effort 7

8. Vermont – data analysis Vermont’s Agency of Human Services has contracted with JEN Associates to assist us with analysis of Medicare and Medicaid Claims data http://www.jen.com/http://www.jen.com/ Claims analysis will include aggregate PMPM analyses for entire population as well as 4 subgroups 8

9. Vermont data analysis - subgroups Analysis of Medicare and Medicaid claims data will be for the following subgroups: –LTC Medicaid –CRT – Community Rehabilitation and Treatment program (Mental Health) –Developmental Services –All other Aged Blind and Disabled 9

10. Purpose of data analysis Create aggregate PMPM for all dual eligibles as well as the 4 cohorts Apply the HCC – Hierarchical Clinical Classification standards to the data to assist the state in the data analysis and subsequent negotiations with CMS http://www3.cms.gov/HealthCareFinancing Review/downloads/04Summerpg119.pdfhttp://www3.cms.gov/HealthCareFinancing Review/downloads/04Summerpg119.pdf 10

11. Vermont is a Medicare plan Model would include expanding upon current Blueprint multipayer effort in Vermont where existing case management systems for Medicaid would be directly linked to Blueprint Community Health teams Better community based coordinated care, we believe, will save both Medicare and Medicaid money and be more effective 11

12. Vermont is a Medicare plan Discuss with CMS: –State is at risk –All Duals are included –Passive enrollment with an opt out provision 12

13. Vermont is a Medicare Plan Discuss with CMS: –Current and previous discussions with providers and advocates in Vermont –Shared savings options –Health care reform offers opportunities for a model like this to work for both a state and CMS 13

14. Questions Brendan Hogan, MSA Acting Commissioner VT Dept. of Disabilities, Aging and Independent Living (802) 241-2401 brendan.hogan@ahs.state.vt.us 14