1. Spoto & Associates, LLC Medicaid Redesign Mike Scribner / Beth Spoto

2. National Medicaid Findings As states search for delivery models which decrease cost and provide more benefit, they are focused on efforts to control Medicaid spending for the highest-cost populations. In 2011: Elderly: 8% of the enrollees  20% of the cost Disabled: 15% of the enrollees  44% of the cost Adults: 27% of the enrollees  14% of the cost Children: 50% of the enrollees  22% of the cost Spoto & Associates, LLC

3. Georgia is one of the lowest in per capita spending Spoto & Associates, LLC StatesAgedDisabledAdultsChildrenUnknownTotal US Average $12,938$14,840$2,668$2,164$975$5,337 Georgia$8,919$9,573$4,046$1,809$0$4,074 Florida$8,456$11,628$2,841$1,785$0$4,573 Alabama$8,110$6,702$1,845$2,169$0$3,928 SC$10,706$11,277$2,847$2,086$0$4,652 NC$10,046$15,004$3,599$2,531$0$5,706

4. Navigant Options Analyzed nine (9) delivery models; Recommend 3: Option 1: Georgia Families Plus Option 2: Georgia Families Plus – Transitioning to “Commercial Style” Managed Care Option 3: Georgia Families Plus – Transitioning to “Commercial Style” Managed Care Program that requires use of PCMHs and ACOs Spoto & Associates, LLC

5. Georgia Families Plus (expansion of current CMO Program) Includes all Medicaid populations Enrollment of Low-Income Medically Needy Adults & potential Medicaid expansion population. Includes all State Plan Service, including behavioral health Value Based Purchasing Medical Home Use – Encourage use of patient centered medical home (PCMH) model Reduced administrative complexities Wellness Programs Spoto & Associates, LLC

6. Recommended Services to Carve In Behavioral health LTC Services Home and community based waiver services Dental services Transportation services Pharmacy services Spoto & Associates, LLC

7. Option # 2 Commercial Style Managed Care Expands Option #1 by potentially adding the following: Use phased approach to enroll patients in “Commercial Style” plans. Employs all levers/innovations that are used in commercial marketplace, such as deductibles and co- pays. Utilizes copays, deductibles, HRAs, incentive payments, prizes, etc. to encourage healthy behaviors. Spoto & Associates, LLC

8. Option #3 Georgia Families Plus “Commercial Style” Managed Care Program with use of ACOs and PCMHs.

9. CMO Feedback Little support for carving in long term care. ABD is a done deal. ACO/PCMH concepts valid; Meeting federal definition is not. Use of commercial style patient payment is ineffective and only lowers provider payment. Use of health rewards has been shown to be effective. 3 – 5 CMOs will be approved. All statewide. Spoto & Associates, LLC

10. What are CMO’s looking for? Willingness to move toward gainsharing mechanisms. Quick network development to support RFP response. Complete statewide network. Ability to address overutilization/high costs. Spoto & Associates, LLC

11. Key Strategic Thoughts: More leverage prior to RFP award. More $’s in gainsharing than in FFS negotiations. What’s in it for you to help a prospect? Do you need to contract with all CMOs? Given current history, be smart about language / administrative items as well. Spoto & Associates, LLC

12. Redesign Timeline: I. Assessment August – December 2011. Completed. II. Recommendation January 2012. Posting of the Strategy Report. January – April 2012. Review and analysis of the Strategy Report. April - Summer 2012. Finalization of the Redesign Model. III. Procurement April – July/August 2012. Procurement planning/workgroups ongoing September/October 2012. Procurement documents posted. (RFP issued) 1 st quarter 2013. Contract award to successful vendors. IV. Implementation January 2014. Implementation begins. Spoto & Associates, LLC

13. Next Steps? Finalization of redesign model. Ongoing discussions with CMOs Spoto & Associates, LLC