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Click to edit Master title style 1 Medicaid Innovations: Can Managed Care Cut Costs and Improve Value? Mary V. Mason, M.D. Senior Vice President and Chief.

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Presentation on theme: "Click to edit Master title style 1 Medicaid Innovations: Can Managed Care Cut Costs and Improve Value? Mary V. Mason, M.D. Senior Vice President and Chief."— Presentation transcript:

1 Click to edit Master title style 1 Medicaid Innovations: Can Managed Care Cut Costs and Improve Value? Mary V. Mason, M.D. Senior Vice President and Chief Medical Officer Alliance for Health Reform Panel Briefing October 28, 2011

2 2 1.6 million members Children Women who are pregnant Adults Foster care Long-term care programs 72% of our members are 18 years old or younger Our Members 0-18 Years old 18+ Years old 0-18 Years old 18+ Years old

3 3 Prenatal and postpartum care Respiratory ailments Diabetes Cardiac disease Mental illness Sickle cell disease Rare diseases Lack of health and wellness education Significant Health Issues Face Our Medicaid Members

4 4 Aligning Resources for Treatment Commonality Resources Less Demand Greater Demand More rare conditions often demand more resources, whereas more common conditions can be managed with fewer resources Hemophilia Sickle Cell HIVPain Mgmt RSV Prevention DMADHDAsthmaPregnancyImmunizations More Common Less Common Cardiac

5 5 Plan Process to Improve Medicaid Member Health Comprehensive approach to combating disease Identification: Centelligence TM Develop Strategy For Results Execution Measuring Outcomes Predictive modeling Provider profiling Quality gaps Evidenced-based guidelines Strong clinical policy Provider partnerships Health literacy Education Professional organizations CentAccount ® Connections Plus ® Community relations Case management Disease management Case coordination

6 6 Start Smart for Your Baby ® We manage the healthcare for more than 70,000 pregnant members each year Centenes comprehensive pregnancy management program Wellness and disease management Case management/care coordination Extends from pre-conception to the first 1-2 years of life of the child Early identification is key –Pre-term births are costly – March of Dimes estimates annual US societal economic burden at $64,000 per pre-term infant* –Customized predictive modeling software helps identify pregnancy URAC 2010 Best Practice Platinum Medalist URAC/GKEN 2010 Best Practice Winner *Source: March of Dimes, Dollar amount includes combined newborn and maternal costs.

7 7 Low-birth weight: under 2500g Low-birth weight: under 1500g Low-birth weight: under 1000g 7.9 percent fewer With use of NOP 20 percent fewer With use of NOP 31.2 percent fewer With use of NOP Improving Outcomes: Start Smart for Your Baby ® The Notice of Pregnancy (NOP) Is Instrumental in Driving Improvement in Pregnancy Outcomes

8 8 Improving Outcomes: Start Smart for Your Baby ® More Expectant Mothers are Participating in the Start Smart Program Timeliness of prenatal care Frequency of Visits Timeliness of postpartum care Plans: OH, TX, GA, IN HEDIS definitions NICU days per 1,000 births dropped from 575 days to 422 days. NICU admission rate fell from 4.61% to 3.79%.

9 9 Improving Outcomes: RSV Program Respiratory Syncytial Virus (RSV) is a major source of respiratory illness in children Program Focus Education Identification Responsible utilization of immunoprophylaxis (Palivizumab) Results Average length of NICU stay is lower 96% compliance with multiple dose therapy 2011 Silver Medalist 2011 Winner

10 10 Improving Outcomes: Hemophilia Program 64 unique members enrolled in coordinated program for Hemophilia and von Willebrands Disease Dosing and assay management Bleed and infusion monitoring Education and care management

11 11 New Program to Achieve Better Outcomes: Sickle Cell Member Population current members with sickle cell, most < 18 years old Over 1/3 of the sickle cell members have had at least 1 ER visit or inpatient stay for crisis in the past 12 months. < 50% of members with 3 or more ER visits or inpatient stays for pain crises in the past 12 months have filled a prescription for hydroxyurea. Treatment with Hydroxyurea It is recommended to consider hydroxyurea in ALL sickle cell patients over the age of 15 due to prolonged survival benefits. Centenes new sickle cell program will focus on increasing member usage of hydroxyurea and identifying other triggers for pain crises such as uncontrolled asthma

12 12 Observations Prevention Funding Supporting Strong Investments Better Alignment of Federal/State Programs on Rules and Payments Coverage (Moms and Post-Partum)


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