1. Medicaid Redesign & Expansion Update Britteny M. Howell Research Analyst Governor’s Council on Disabilities & Special Education

2. Medicaid Redesign & Expansion Contractors o Agnew::Beck o Health Management Associates o Milliman, Inc (actuarial analysis) Webinar on Jan 26 at noon Currently, Alaska is one of only two states whose Medicaid program relies exclusively on a fee-for- service payment model.

3. Medicaid Redesign & Expansion The report recommends a package of 5 reform initiatives aimed at improving the health of Alaskans and reducing overall costs. Initiatives 1 through 3 propose foundational reforms that create the incentives, services, management structures and controls, data analytics capacity, and technology infrastructure. Initiatives 4 and 5 are pilots that would allow DHSS to test value-based payment mechanisms.

4. Medicaid Recommendations INITIATIVE 1: PRIMARY CARE IMPROVEMENT INITIATIVE INITIATIVE 2: BEHAVIORAL HEALTH ACCESS INITIATIVE INITIATIVE 3: DATA ANALYTICS AND INFORMATION TECHNOLOGY INFRASTRUCTURE INITIATIVE INITIATIVE 4: EMERGENCY CARE INITIATIVE INITIATIVE 5: ACCOUNTABLE CARE ORGANIZATIONS INITIATIVE/SHARED SAVINGS/SHARED LOSSES MODEL

5. INITIATIVE 1: PRIMARY CARE IMPROVEMENT INITIATIVE Primary Care Case Management o Every enrollee selects, or is assigned, a primary care provider who coordinates their care Annual Health Risk Assessments o Identifies those with higher health neesd & risks Health Homes and other care management programs o Ensure needs addressed as early and appropriately as possible o DHSS contracts with Administrative Services Organization to conduct outreach, education, performan assessments, manage assignment of enrolls, develop & manage primary care provider network

6. INITIATIVE 2: BEHAVIORAL HEALTH ACCESS INITIATIVE Propose 115 Waiver o Demonstration waiver that would secure authoirty & additional resources to broaden behavioral health services and increase capacity in DHSS o Could include substance use disorder treatment delivery system efforts Administrative Services Organization (ACO) o Contractor to perform support for behavioral health system like develop and manage network of providers, utilization management, outcomes reporting, fraud and waste abuse auditing Integrate primary care with mental health services o Establish standards of care that allow providers to bill Medicaid o Requires a statute change, as only clinical social workers and psychologists can bill Medicaid for behavioral health right now

7. INITIATIVE 3: DATA ANALYTICS AND INFORMATION TECHNOLOGY INFRASTRUCTURE INITIATIVE Increase utility of existing Health Information Exchange (HIE) o Connects hospitals, emergency departments, community-based providers o Integrates Prescription Drug Monitoring Program database o Increase shared information among providers and analyze health data to improve health outcomes & decrease costs Advanced Data Analytics Contractor o To provide program-level data analysis to DHSS and provdiers to drive quality and cost containment

8. INITIATIVE 4: EMERGENCY CARE INITIATIVE Partership between DHSS, Alaksa State Hospital & Nursing Home Association, and Alaska Chapter of American College of Emergency Physicians o Get emergency departments to use Alaksa’s HIE to share Medicaid enrollee patient data to prevent emergency department use & facilitate follow-up with primary care and behavioral health providers o Would increase service utilization, reduce Medicaid costs, improve care, and reduce prescrption opioid misuse

9. INITIATIVE 5: ACCOUNTABLE CARE ORGANIZATIONS INITIATIVE/SHARED SAVINGS/SHARED LOSSES MODEL Accountable Care Organizations (ACO) o Pilot value-based payment system for quality health care by contracting with groups of providers (ACOs) o An ACO is a group of providers that agrees to share responsibility for the cost and quality of health care for defined patient populations o Projects total cost of care and the ACO is eligible for a portion of the savings or losses that results from the health care delivery o Incentivizes continuous quality improvement o Recommended to establish workgroups to support ongoing partner engagement and develop recommendations for telemedicine and business improvement processes

10. Medicaid Redesign & Expansion Over next 5 years, these initiatives could save the state up to $600 million dollars. This report does not include 1915 i and k state plan initiatives that are being researched by SDS. QUESTIONS??