Medicare/Medicaid Coordination: Outlining the Future Imprint R. Meiners Ph. D. National System Executive Robert Wood Joh

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Medicare/Medicaid Integration: Charting the Future Mark R. Meiners Ph. D. National Program Director Robert Wood Johnson Foundation Medicare/Medicaid Integration Program New York State Medicaid Managed Care Conference, Beyond Managed Care: Striving for Excellence , Saratoga Springs, NY, May 30-31, 2006

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Background to MMIP Experiences Robert Wood Johnson Foundation 15 Participating States: CO, FL, MN, NY, OR, TX, WA, WI, VA, CT, MA, ME, NH, RI, VT For Background and Technical Assistance Documents go to: CHPRE.GMU (click: Medicare/Medicaid Integration Program)

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Why the Interest in Dual Eligibles? Essential open financing contemplations Cost moving in both bearings Unintended shopper results A chance to improve constrained assets Managed mind suggestions Aging of the populace/Chronic Care Imperative

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Key Dimensions of Dual Eligible Integrated Care Program Development » Scope and adaptability of advantages - more than M&M expense for-administration » Delivery framework - wide, broad, choices, encounter » Care combination - mind groups, focal records, mind coordination . » Program organization - select, dis-enlist, incorporated information & IS » Quality administration and responsibility - brought together, expansive , CQI » Financing and installment - adaptable, adjusted motivating forces

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State Environmental Diversity Major contrasts in Medicaid programs Wide varieties in state oversaw mind infrastructure Differences in state objectives and target populations States are in different phases of program development Divergent meanings of joining/coordination

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Program Development Options Budget Neutral or Cost Saving Statewide or local pilot (huge versus constrained) Mandatory or Optional Duals/Medicaid-just Aged/Disabled Both? Timing? Indeed, Community Frail, Nursing Home National MCOs or Local Safety-Net Providers Provider Networks – open or shut? Waivers, Risk Adjustment, Enrollment Strategy M/M Coordination or Integration Benefits: Comprehensive/Carve Outs

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RWJF Medicare/Medicaid Integration Program Medicare Coordination Managed FFS Medicare Integration Issues/Features Medicaid and Medicare repaid FFS No waivers required Care facilitator interface amongst projects and suppliers Use of motivating forces (expenses, co-area, reporting) Issues/Features Medicaid LTC capitated Medicare HMO select empowered Various Medicaid waivers/powers Inability to catch Medicare funds Case administration needs power over Medicare Issues/Features 222 Medicare installment waiver & Various Medicaid waivers One contract for both payers Flexibility to utilize investment funds for non-customary administrations Case administration has control over both projects

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Models: Buy-In Wraparound Capitated Wraparound Three-Party Integrated Plan-Level Integrated Key Considerations: Enrollment Operations Benefits Payments Appeals Part D Implementation CMS Guidance to Integrating Medicare/Medicaid

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Chronic Care Model Community Health System Health Care Organization Resources and Policies Clinical Information Systems Self-Management Support Delivery System Design Decision Support Prepared, Proactive Practice Team Informed, Activated Patient Productive Interactions Improved Outcomes

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P An A D S D An A P An A P S D P An A D S Overall Aim: Implement the CCM for a particular Dual Eligible/Chronic Care Population Community Resources and Policy Organiz-ation of social insurance Clinical Information Systems Self-Manage-ment Support Delivery System Design Decision Support Develop Strategies for Each Component of the CCM

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Core Building Blocks Targeting Beneficiaries: Risk versus Remunerate Case Management/Care Coordination - Integrating Information Quality Methods and Measures Primary Care/Chronic Care Management

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Quality/Consumer Focused Care Is the Key: Look at quality from different points of view (i.e., shopper, supplier, payer) Look at whole picture Consider structure, process and results

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Key Micro Strategy: Primary Care Teamwork Focus on all encompassing methodology including wellbeing and welfare (e.g., psychosocial, monetary, environmental, social backings) Monitor continuous wellbeing status for early identification of problems Emphasize wellbeing training and counteractive action Support unending consideration self administration Increase open doors for correspondence

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Summary Thoughts for Discussion Integrated Care Programs should be expanded and reproduced. Extraordinary Needs Plan speak to both opportunity and test to IC. Nonstop Quality Improvement Evaluation is fundamental going ahead.