CMS Grant Programs: Improving Access Quality for Medicaid Beneficiaries and the Uninsured

Presentation Transcript

CMS Grant Programs: Improving Access & Quality for Medicaid Beneficiaries and the Uninsured Jessica Pollak Kahn, MPH Centers for Medicare & Medicaid Services

Presentation Objectives Medicaid Transformation Grants - $150m High Risk Insurance Pool Grants - $49.1m Emergency Room Diversion Grants-$50 2008 Uninsured Congress

Innovation Change Catalyst Transformation 2008 Uninsured Congress

Medicaid Transformation Grants Purpose: Section 6081 of the DRA adds another subsection to the Social Security Act which gives give assets to the selection of creative techniques to enhance the adequacy and productivity in giving therapeutic help under Medicaid 2008 Uninsured Congress

Allowable Projects Electronic wellbeing records , electronic clinical choice bolster apparatuses , & e-endorsing programs; Methods for enhancing rates of gathering from homes of sums owed under Medicaid; Methods for decreasing waste, extortion, and mishandle , solution chance administration programs 2008 Uninsured Congress

Allowable Projects Continued Methods in diminishing, in clinically fitting ways, Medicaid consumptions for secured outpatient drugs, by expanding the use of bland medications using training programs and different motivators to advance more noteworthy utilization of non specific medications 2008 Uninsured Congress

Who and How Much$? $150 million granted to Medicaid organizations in 35 States, Puerto Rico and the District of Columbia 2/3 of gifts are centered around wellbeing data innovation Electronic wellbeing records E-recommending Health data trades Predictive demonstrating frameworks 2008 Uninsured Congress

Intended Reforms from MT Grants Improved care coordination through HIT/E will bring about: Reduced duplicative testing and screening Fewer antagonistic medication occasions Fewer missed open doors/enhanced adherence to treatment guidelines Improved recipient fulfillment with care 2008 Uninsured Congress

Other MT Grant Focus Areas Improved Neonatal Outcomes Improved Fraud & Abuse Detection Improved Pharmacotherapy with Predictive Modeling Improved Case Management with Predictive Modeling Streamlined Medicaid Eligibility and Citizenship Determination Automated Pharmacy and HCBS Pre-Authorization Systems 2008 Uninsured Congress

Example Medicaid Transformation Grant: Texas Health Passport For kids who are both Medicaid-qualified and in the TX child care framework Costs were 5x that of comparative youngsters in Medicaid however not in child care Creates an online framework that tracks their wellbeing use, drugs, lab comes about, behavioral wellbeing notes, and so on for use by restorative suppliers, child care case managers and guardians Will streamline their care, lessen duplication of testing and enhance multi-disciplinary group coordination 2008 Uninsured Congress

Example Medicaid Transformation Grant: Alabama Together for Quality: Transferring the majority of the Medicaid recipient records to electronic wellbeing records Creating a HIE between Medicaid suppliers Web-based, free EHR for suppliers that incorporates e-endorsing and clinical choice bolster Also testing this approach with upgraded tend to people with endless illnesses Using HEDIS measures for diabetes and asthma to track results Tremendous partner inclusion 2008 Uninsured Congress

Multi-State Collaborative for HIT and Medicaid After the first of 2 sales adjusts in 2007, 14 states stepped up with regards to shape a multi-state joint effort of MT Grantees, concentrating essentially on HIT/EHR work. Sharing lessons learned Defining measures Joint acquirement Open source codes Peer to companion critical thinking 2008 Uninsured Congress

More Info on MTG Final Evaluation Reports due 6 months after stipends end ��  liable to be fall of 2010 www.cms.hhs.gov/MedicaidTransGrants/2008 Uninsured Congress

Coverage Access Security Quality 2008 Uninsured Congress

High Risk Insurance Pools Comprehensive health care coverage programs focusing on people who can't get medical coverage in the private market in light of prior wellbeing conditions. CMS awards since 2003 Thirty-five states have a dynamic high hazard pool concede from CMS. 31 are operational high hazard pools; 4 are seed awards. 2008 Uninsured Congress

High Risk Pools Grants To be qualified for a CMS concede, they should take after 1 of the 2 models in the NAIC Model Health Plan for Uninsurable Individuals Act Most give case administration, illness administration & avoidance screenings Most offer either premium decrease programs for all individuals or potentially low-wage premium endowments with government allow stores. 2008 Uninsured Congress

High Risk Pools & HIPAA Many States utilize the pools to follow P.L. 104-191 Health Insurance Portability and Accountability Act of 1996 (HIPAA). For qualified people moving from the gathering to the non-assemble showcase, HIPAA requires state-authorized wellbeing guarantors to make scope accessible to such people, and forbids avoidance of scope for prior conditions. Around 29 of the pools are guaranteed as a HIPAA elective system. 2008 Uninsured Congress

High Risk Pool Funding Federal monetary year 2006: $90 million Federal financial year 2008: $50 million Funding is designated by 3 components: Ranking by 3-year normal number of uninsured per state (US Census) Ranking by number of people selected in the high hazard pool in earlier year Divided similarly among every single qualified candidate 2008 Uninsured Congress

High Risk Pools: The Stats The most minimal normal # of uninsured were: MN, IA, WI. The most noteworthy normal # of uninsured were: TX, NM, LA, MS The biggest pools are: Minnesota (28,859 in 2007). Likewise most seasoned. Texas (27,733) Oregon (18,656) Wisconsin (17,126) 2008 Uninsured Congress

High Risk Pools: More Detail Most high hazard pools are supported to a limited extent through appraisals exacted against private safety net providers in their state Most incorporate representation from private back up plans on their Board enrollment Claims paid dependably surpass premiums gathered, given the high dreariness of their individuals 2008 Uninsured Congress

What Role Do They Play in Assuring Access to Health Care? Two sides of the coin: Heads: Serve as a wellbeing net for those with prior restorative conditions who might not generally have the capacity to get scope. While costly, offers a far reaching protection bundle where none existed Broad supplier systems Fashioned particularly for those with ailments as well as interminable conditions 2008 Uninsured Congress

The Pros & Cons Continued Tails: Allows the private protection market to "carefully select" who it will offer scope based upon hazard/cost shirking Premiums are high and not moderate to all Benefits change pool to pool Doesn't exist in all states Board agents from private safety net providers may have disincentives for pool development since that builds their evaluations 2008 Uninsured Congress

Future of High Risk Pool Grant Funding CMS asked for subsidizing in FY09 and FY10 for support of state high hazard protection pools After 2010, extra approval is required from Congress to proceed with the concede program 2008 Uninsured Congress

More Info on High Risk Pools www.cms.hhs.gov/highriskpools/National Association of State Comprehensive Health Insurance Plans: www.naschip.org 2008 Uninsured Congress

Emergency Access Referral Alternatives Coordination 2008 Uninsured Congress

Alternate Non-Emergency Providers The August 6, 2008 NHS Report expresses that in 2006, 13.9% of the Medicaid/SCHIP crisis office visits were for non-earnest reasons. It is those preventable occasions focused by the new $50 million CMS concede program, approved by the DRA of 2005 to give Federal give assets to States to set up exchange non-crisis benefit suppliers. 2008 Uninsured Congress

Emergency Room Diversion Grants Nearly 11% of all mobile medicinal care visits in the US happen in healing facility crisis divisions This concurs with diminishing quantities of crisis offices and quantities of in-patient doctor's facility beds. The outcome? Stuffing and not exactly ideal care 2008 Uninsured Congress

ER Diversion Grants: Who & How Much $? 20 State Medicaid organizations were granted $50 million in April 2008 for 29 isolate ventures CO, CT, GA, IL, IN, LA, MA, MD, MI, MO, NJ, NC, ND, OK, PA, RI, SD, TN, UT, WA Preference given to extend in restoratively underserved zones & for collaborating with neighborhood, group doctor's facilities 2008 Uninsured Congress

Variety of Approaches Identification of high-clients - > outreach HIT as a feature of the ER & therapeutic home circle Care facilitators co-situated inside the ER Specialty coordination for substance mishandle, psychological wellness and endless medicinal conditions New essential care get to focuses Expanded night and weekend hours Mobile centers Telemedicine Urgent care facilities School-based essential care centers 2008 Uninsured Congress

Expected Reforms Decreased utilization of taking an interest clinic crisis divisions by Medicaid recipients for non-new reasons Decreased cost to Medicaid Increased recipient fulfillment Improved ED proficiency as it adds to a diminishment in over-swarming Increased use of "medicinal homes" Improvements in endless care administration and results Improvement in preventive care 2008 Uninsured Congress

More Expected Outcomes Improved care coordination Predictive displaying to distinguish high-require people and give focused on case administration Increased usage of wellbeing data innovation and online booking apparatuses 2008 Uninsured Congress

More Info on the ER Diversion Grants Final Evaluat