INTERIM UPDATE MEDICAID REFORM MANAGED CARE STUDY May 2013

STUDY BACKGROUND SEA0082 passed by Wyoming Legislature (2013) Requires WDH to explore the use of managed care for the Medicaid population “The department shall explore the use of managed care for all or a designated part of the Medicaid population, with the goal of delivering care of the same or better quality as currently delivered but at reduced cost. The managed care plan shall include identification of goals, outcome measurements and evaluation tools...” See SEA0082 Section 1(a)(i)(D)

WHAT IS MANAGED CARE? No singular definition, a range of designs and tools Approaches range from ‘no risk’ contracts to ‘full risk’ contracts Can be tailored to population needs: Urban areas may use full-risk, comprehensive managed care plans Rural/frontier areas may only be able to support primary care case management approaches Limited benefit plans can be applied to different populations for different services SOURCE: o_Option_for_Managed_Care.pdf o_Option_for_Managed_Care.pdf

WHY MANAGED CARE? A successful model of managed care should meet the following goals: Control costs Health care costs growing faster than GDP Reduce inappropriate use of services Improve quality Improve population health Increase preventive services

MANAGED CARE: EXAMPLE DESIGNS Primary Care Case Management (PCCM) Ensures that enrollees have a primary care provider who receives a small monthly per capita payment (an administrative fee) to coordinate each enrollee’s care. All services are still paid on a fee-for-service basis. Limited-benefit plans Typically covers a single type of benefit, paid on a capitated basis. Comprehensive risk-based managed care Typically incorporates a health maintenance organization (HMO) model in which enrollees must use a network of providers. States pay on a capitated basis. SOURCE: IP/Idaho_Option_for_Managed_Care.pdf IP/Idaho_Option_for_Managed_Care.pdf

MANAGED CARE AND LONG TERM CARE High cost of long term care services to Medicaid Medicaid programs are now more likely to consider managed care approaches to address this population Goal of Integrating Long Term Care Services in Managed Care Develop a person ‐ centered system of care that addresses range of individual needs by: Safely decreasing institutional utilization Improving clinical and quality outcomes Building on consumer choice

WDH DEFINITION OF MANAGED CARE For the purposes of this study, ‘managed care’ is: Any system of healthcare delivery that focuses on management of healthcare services with the intent to provide integrated and coordinated care at a lower cost. This could be accomplished using various service delivery models and payment methods Focus: those that will function well in a rural/frontier state Currently, WDH is not focused on any one model

STUDY PURPOSE Purpose To explore models and methods uniquely created to fit a State’s rural/frontier characteristics To recommend a managed care model that delivers care of the same or better quality as currently delivered, at a reduced cost (only if feasible for Wyoming)

WDH PLAN: PART ONE Part 1 The chosen Consultant will: Research models of managed care and payment methods Conduct outreach to clients, advocates, providers Provide recommendations to WDH about feasibility of various models in Wyoming,including recommendations on: most appropriate models of managed care most appropriate payment methods most appropriate categories of recipients, and any combination thereof Gather information from organizations interested in managing the care of the Wyoming Medicaid population

WDH PLAN: PART TWO Part 2 The chosen Consultant will: Research/analyze viability of specific benefits of any recommended models The goal is to deliver same or better quality care at lower cost

WDH PLAN: PART TWO (2) Part Two should provide answers to the following questions: 1) Could costs be reduced, and if so, by how much and over what period of time? 2) Could healthcare quality be maintained or improved, and if so for which measures? 3) Could population health be improved and preventive services increased, and for which conditions? 4) Could healthcare access and provider participation be maintained or improved?

WDH PLAN: PART THREE Part 3 The chosen Consultant will: Provide technical assistance and/or planning guidance to WDH in drafting final recommendations on use of managed care in Wyoming If appropriate, provide technical assistance to the WDH in the creation of a high-level planning document Be prepared to provide additional technical assistance on an as requested basis at an hourly rate

IN-DEPTH: STAKEHOLDER PROCESS Stakeholder input will be sought by Consultant during Part 1 of study Clients Advocates Providers Stakeholders will be asked to comment via survey and/or interviews on: Features of managed care models that could work in Wyoming Features of payment methods in a managed care structure Viability of various models and methods in current provider structure Impact of implementing managed care elements on clients and providers Provider/client participation

MANAGED CARE RFP WDH Study Team guided development of RFP Deliverables include: Work plan for study and related final report Bi-monthly written updates/progress reports Medicaid stakeholder outreach (online surveys, interviews) Draft and final report of research and analysis of managed care models Recommendations of managed care models for Wyoming Released May 15, 2013

STUDY TIME FRAME Responses to RFP due June 5, 2013 Study will commence by July 15, year contract Anticipated completion: July 15, 2014

THANK YOU Questions?