Janet Grant CareSource Management Group Executive Vice President Business Development and Regulatory Affairs Medicaid Conference September 24, 2008 Contracting as a Dual Eligible Special Needs Plan: Lessons Learned from Navigating the Medicare Program

2 CareSource Mission: Making a difference in the lives of underserved people by improving their health care Medicaid focused non-profit health plans –Ohio: 625,000 Medicaid members –Michigan: 50,000 Medicaid members 19 years of Medicaid managed care experience SNP plans launched in both states January 2008

3 CareSource SNP Goals Extend CareSource mission Provide a continuum of care for Medicaid ABD members Leverage plan Medicaid expertise; knowledge of Medicaid population needs Invest in infrastructure to partner with states on highest acuity and cost populations Vehicle for Medicare/Medicaid integration Diversify product lines

4 SNP Launch Lessons Learned Network, network, network….. –Time and resource commitments –Armed for provider questions/resistance Use of consultants to jump start, provide technical assistance Leadership to demonstrate priority, organizational commitment, recognition of resource requirements Organizational involvement, need to learn MA and think through how to operate Marketing, marketing, marketing…..

5 Competencies Required Medicare regulatory requirements Sales/marketing, enrollment Financial/benefit bid: actuarial expertise Risk adjustment management Network development Pursue state Medicaid integration

6 State Challenges

7 State Opportunities Integration to increase quality of care and consumer satisfaction Decrease provider administrative burden Support rebalancing of facility based vs community based LTC Savings associated with delay/prevention of facility based LTC

8 State Challenges Knowledge of SNP and integration potential Concern that savings accrue to Medicare Other budget and policy priorities Technology to support Stakeholder resistance Statewide SNP coverage Statutory carve out of duals from Medicaid managed care Voluntary MA enrollment Operational challenges of integration

9 Tale of two states… Ohio CMS SNP 101 SNP Work Group ABD seamless enrollment Technical assistance –Expert consultation –Savings analysis Michigan Plan for capitation ABD seamless enrollment Consumer education

10 MI Consumer Education

11 Stakeholder Involvement Disability advocates –Community Catalyst SNP Consumer Education Project Area Agencies on Aging Low income housing Continuing Care Retirement Communities (CCRCs)

12 Stakeholder Shared Goals Right care in the right place Least restrictive environment Case management as central strategy Promote medical home Quality outcomes and customer satisfaction Coordinated care

13 Current Issues SNP reauthorization State contracting requirement and impact on service area expansion opportunities Medicare/Medicaid integration Identification and education of eligible dual consumers