KanCare Renewal Stakeholder Feedback Forums May 24, 25 and 26, 2016; 1:00-3:00 and 5:30-7:30 pm Topeka, Kansas City, Wichita, Hays & Pittsburg, Kansas

KanCare Stakeholder Forums KanCare Renewal Stakeholder Feedback Forums 2 New waiver has not been written yet, we are in the information-gathering stage Meetings are for gathering information from members and providers on general issues and some specific policy options 10 meetings across the state We will be holding additional meetings throughout the Summer to collect more specific feedback FAQs from these sessions will be posted to the KanCare website as soon as possible

KanCare – Time To Renew KanCare Renewal Stakeholder Feedback Forums 3 Started on Five-year demonstration program approved by Centers for Medicare & Medicaid Services Plan to submit application for renewal by end of this year Renewal effective We want your input for the renewal application

KanCare Overview - Current KanCare Renewal Stakeholder Feedback Forums 4 KanCare 1115 Waiver Project In year 4 of a 5 year demonstration 95% of populations and services included Break down silos of care Improve quality/outcomes while bending cost curve down Provide integrated, coordinated care Increased emphasis on health, wellness, prevention, early detection and early intervention

Current KanCare Beneficiaries 5 Children Pregnant Women Individuals with disabilities (physical, intellectual, developmental) Technology assisted children Kids with autism Frail elderly Able-bodied parents/caretakers under 38% FPL Individuals with traumatic brain injury Individuals with severe emotional disturbance Individuals with breast and cervical cancer Individuals with tuberculosis Individuals with HIV and AIDS

KanCare Benefits for Kansas KanCare Renewal Stakeholder Feedback Forums 6 Added new services and benefits (Bariatric surgery, heart and lung transplants and Value Added Services) 2013 through 2015 Total members getting value added services Total units of value added services provided Total value of value added services provided Combined three KanCare MCOs 520,5151,722,637$14,634,532

KanCare Cost Comparison KanCare Renewal Stakeholder Feedback Forums 7

Medicaid Cost by Population KanCare Renewal Stakeholder Feedback Forums 8 SFY 2013SFY 2014SFY 2015 Children/Families $758,635,561$912,105,856$1,018,413,861 Individuals with Disabilities $1,195,106,320$1,261,568,920$1,329,427,581 Elderly $516,331,676$537,847,233$587,174,646 MediKan/Other $33,276,183$34,644,315$27,276,844 TOTAL $2,503,349,740$2,746,166,325$2,962,292,931

KanCare - Utilization Comparison KanCare Renewal Stakeholder Feedback Forums 9

KanCare Renewal - Process KanCare Renewal Stakeholder Feedback Forums 10 Conduct Renewal Stakeholder Forums May 2016 Develop Draft Renewal Application June-July 2016 Post Application for Review and Tribal Consultation Aug.-Sept Renewal Application Submitted to CMS November 2016 CMS Public Notice & Consultation With State Throughout 2017 CMS Decision & Special Terms and Conditions Issued By

KanCare – Potential Changes KanCare Renewal Stakeholder Feedback Forums 11 Continued improvement in coordination and integration of care Payment based on outcomes and value Waiver Integration

Coordination/Integration of Care KanCare Renewal Stakeholder Feedback Forums 12 When we renew the program, we want to ensure that care coordination is effectively used to increase integration of member care clarify roles among MCOs and community providers reduce the potential for duplication of services target greatest resource to greatest need be flexible where necessary about how service is delivered

Questions to Consider KanCare Renewal Stakeholder Feedback Forums 13 What is working well with care coordination that we want to keep? What could be improved about the care coordination process? What is missing that would make care coordination more effective and work for you?

Outcomes-Driven Payment KanCare Renewal Stakeholder Feedback Forums 14 Outcomes-driven payment defines how we pay for care Main feature is that it ties payment (or enhanced payment) to better health outcomes Most common approaches are Paying providers more for meeting performance targets Episode-based payments Population-based care

Pay for Performance Plan - Iowa KanCare Renewal Stakeholder Feedback Forums 15 Focus on patients with multiple chronic illnesses PCPs receive tiered PMPM based on number of chronic conditions member has Providers earn bonus incentives based on performance against benchmarks in four areas: Preventive care Chronic illness care Adult or pediatric specific chronic care measures Mental health

Episode Based Payments KanCare Renewal Stakeholder Feedback Forums 16 Example for Asthma Include cost related to care during the attack and all of the related care for a period of 30 days after the event Hospital admissions Readmissions Post acute care

Population Based Payment Model KanCare Renewal Stakeholder Feedback Forums 17 Primary Care Doctor contracting for care of patients Provider takes on responsibility for a vast majority of the health care provided if they directly provide all care or not Most often include acute care, chronic conditions, and certain behavioral health conditions Risk is shared by payer and provider If costs for the population go down the provider can share in the savings If costs go up the payer covers a part of those increased costs

Population Based Payment Model - Outcomes KanCare Renewal Stakeholder Feedback Forums 18 Ability to share in savings or increased costs is often tied directly to performance measures that indicate better health for the impacted population Most models reward providers at a higher rate if reduced costs are directly related to better health outcomes for the patients Models often penalize providers that drive down costs but also show poorer health outcomes Do not reward providers that withhold care to drive down costs

Questions to Consider KanCare Renewal Stakeholder Feedback Forums 19 What provider types or groups should be considered first? Which diagnoses, conditions or procedures should be considered first? What results should be rewarded?

Waiver Integration KanCare Renewal Stakeholder Feedback Forums 20 To create parity for populations served through HCBS – services should be based on a personalized plan of care and centered on individual needs rather than their disability To offer a broader array of services – some individuals have disabilities that qualify them for more than one HCBS program, but are limited to a single set of services Entrance to HCBS will remain the same, but services will fall into two broader categories: Children’s Services Adults’ Services

Questions to Consider KanCare Renewal Stakeholder Feedback Forums 21 1.What barriers have you experienced in access home and community based services? 2.What services would you like to have the state consider in order to offer a broader array of services under a more flexible program? 3.On what timeline would you like to see these changes occur? 4.What would you want to make sure to preserve from the current home and community based services programs?

KanCare – Other Issues KanCare Renewal Stakeholder Feedback Forums 22 Strengthening supports to obtain/maintain competitive, integrated employment Use of block grant structure for Kansas Medicaid services Other suggestions from you

KanCare Renewal - Input KanCare Renewal Stakeholder Feedback Forums 23 After today, if you have additional feedback or questions about the renewal, please submit them to: Public hearings will be scheduled in August, once a draft of the application is done and posted for review Please check for updates at

KanCare Renewal Stakeholder Feedback Forums 24 Thank you!