1 State of Vermont Demonstration to Integrate Care for Dual Eligible Individuals Financing Model Workgroup Meeting #1: July 26, 2011

2 Agenda Project Objectives Project Objectives Project Deliverables and Timeline Project Deliverables and Timeline Overview of Project Organization Overview of Project Organization Discussion of Financing Model: Key Components and Decisions Discussion of Financing Model: Key Components and Decisions Discussion of Financing Model Workgroup Topics/Tasks, Resources and Schedule Discussion of Financing Model Workgroup Topics/Tasks, Resources and Schedule Discuss Goals and Objectives of Financing Model Discuss Goals and Objectives of Financing Model

3 Project Objectives Our goal is to develop a person-centered model that achieves the following objectives: Improves quality of care and quality of life Improves quality of care and quality of life Enhances flexibility and member choice Enhances flexibility and member choice Improves care coordination Improves care coordination Manages program costs Manages program costs Supports Vermont’s broad health reform goals Supports Vermont’s broad health reform goals

4 Project Deliverable Vermont must prepare a demonstration proposal that describes how the state would structure, implement, and evaluate an integrated delivery system and payment model aimed at improving the quality, coordination, and cost-effectiveness of care for people who are dually eligible for Medicare and Medicaid. Vermont must prepare a demonstration proposal that describes how the state would structure, implement, and evaluate an integrated delivery system and payment model aimed at improving the quality, coordination, and cost-effectiveness of care for people who are dually eligible for Medicare and Medicaid. This demonstration design proposal represents the ‘deliverable’ under a CMS contract with the State of Vermont. This demonstration design proposal represents the ‘deliverable’ under a CMS contract with the State of Vermont. The goal of the current award from CMS is for the state of Vermont to design a model to become the at-risk Medicare Managed care entity for all Vermonters who are dually eligible for Medicare and Medicaid in Vermont The goal of the current award from CMS is for the state of Vermont to design a model to become the at-risk Medicare Managed care entity for all Vermonters who are dually eligible for Medicare and Medicaid in Vermont

5 Project Timeline

6 Overview of Project Organization Workgroups Service Delivery Financing Person- Centered Care Outcomes and Quality Stakeholder Advisory Group AHS Steering Committee Project Staff

7 Financing Model Key Components and Policy Decisions Provider Payment Provider Payment Cost Shifting Incentives Cost Shifting Incentives Medicare v. Medicaid Methodologies, Rates & Coverage Medicare v. Medicaid Methodologies, Rates & Coverage Service Authorization Processes Service Authorization Processes Claims Processing Claims Processing Administrative Efficiency Administrative Efficiency Innovative Payment Models Innovative Payment Models Development of individual budgets, based on clinical/functional needs and choices Development of individual budgets, based on clinical/functional needs and choices Performance-Based Models Performance-Based Models Medicare Funding Medicare Funding Evaluation of historical expenditures Evaluation of historical expenditures Evaluation of Medicare Advantage Rate Methodology/Hierarchical Condition Categories (HCCs) Evaluation of Medicare Advantage Rate Methodology/Hierarchical Condition Categories (HCCs)

8 Discussion of Financing Model Workgroup Topics/Tasks, Resources and Schedule MeetingTopic(s)/Task(s)Resources 1 July 26 Project Background Project Objectives Project Deliverables and Timeline Overview of Project Organization Discussion of Financing Model: Key Components and Decisions Discussion of Financing Model Workgroup Topics/Tasks, Resources and Schedule Discuss Opportunities, Principles and Challenges Project Proposal to CMS Overview of Advisory Groups and Workgroups Act 48 of 2011 (Single pipe system) Opportunities 2 August 11 Review Current Payment Methodologies Identify Advantages and Disadvantages: Current Medicare and Medicaid Reimbursement Approaches Identify Cost Shifting Incentives Between Two Programs Comparison of Payment Methodologies 3 August 26 Reimbursement Methodology Options by Service Type (Hospital, Physician, Home Health, Nursing Facility, Specialized Services (DS, MH, CRT, TBI, LTC, SA), Pharmacy, Other Services) Payment Rate Principles/Options Available Service and Expenditure Data List of Cost Shifting Incentives List of Advantages and Disadvantages: Current Payment Approaches

9 Discussion of Financing Model Workgroup Topics/Tasks, Resources and Schedule MeetingTopic(s)/Task(s)Resources 4 Sept. 9 Discussion of Innovative Payment Approaches Performance-Based Approaches Individual, Needs-Based Budgets Population/Community-Based Budgeting Peer-organized Models Vermont Payment Reform Update Available Service and Expenditure Data 5 Sept. 23 Service Monitoring Quality of Care Access to Care/Network Adequacy Sustainability of Provider System Peer Oversight Opportunities to Improve Access Service Coverage Provider Participation Workforce Development Preliminary Findings: Outcomes and Quality Workgroup Preliminary Findings: Service Delivery Group 6 October 7 Review Payment and Service Coverage Approaches Principles Opportunities Options Resource/Infrastructure Needs Claims Processing Program Monitoring Listing of Payment and Service Coverage Options

10 Discussion of Financing Model Workgroup Topics/Tasks, Resources and Schedule MeetingTopic(s)/Task(s)Resources 7 October 20 Review Linked Medicaid/Medicare Data Review Opportunities Reduce Cost Shifting Improve Service Delivery Review Medicare Funding Options for Demonstration Model Linked Data Reports Medicare Funding Options 8 Nov. 3 Review Draft Proposal: Provider Payment and Monitoring Review Draft Proposal: Payment Reform (Medicare Funding Under Demonstration) Draft Provider Payment and Monitoring Section of Proposal Draft Payment Reform Section 9 Nov. 16 Review Draft Proposal Draft Proposal 10 Nov. 30 Review Final Draft Proposal Final Draft Proposal

11 Discussion of Opportunities, Principles and Challenges: Financing Model Opportunities Opportunities Improved administrative efficiency Improved administrative efficiency Principles Principles Preserve and enhance access to services Preserve and enhance access to services Challenges Challenges Developing budget neutral payment approaches Developing budget neutral payment approaches