Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a...

18
Clinical Programs for Clinical Programs for Medicaid Enrollees with Medicaid Enrollees with Disabilities and Chronic Disabilities and Chronic Illnesses Illnesses Results of a National Survey Results of a National Survey Presented by Carol Tobias, Presented by Carol Tobias, Director Director Medicaid Working Group Medicaid Working Group Boston University School of Boston University School of Public Health Public Health Funded by the Center for Health Care Funded by the Center for Health Care Strategies - 2000 Strategies - 2000

Transcript of Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a...

Page 1: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Clinical Programs for Medicaid Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Enrollees with Disabilities and Chronic IllnessesIllnesses

Results of a National SurveyResults of a National SurveyPresented by Carol Tobias, DirectorPresented by Carol Tobias, Director

Medicaid Working Group Medicaid Working Group

Boston University School of Public HealthBoston University School of Public HealthFunded by the Center for Health Care Strategies - 2000Funded by the Center for Health Care Strategies - 2000

Page 2: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

2

Health Plan ResponsesHealth Plan Responses

• 127 plans (+-) enroll the SSI population127 plans (+-) enroll the SSI population• 61 health plans responded - 48% response 61 health plans responded - 48% response

raterate• 61% predominantly (>75%) Medicaid plans61% predominantly (>75%) Medicaid plans• 39% commercial + Medicaid plans39% commercial + Medicaid plans• 59% also enroll Medicare beneficiaries59% also enroll Medicare beneficiaries

Page 3: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

3

StatesStates

Arizona 2 Mass. 2 Oregon 6

California 8 Maryland 3 Penn. 3

Colorado 2 Michigan 6 Tenn. 3

D.C. 1 Missouri 3 Texas 1

Delaware 1 Nebraska 2 Utah 5

Florida 3 New Mexico 2 Wisconsin 3

Kentucky 1 New York 4

Page 4: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

4

Total Medicaid EnrollmentTotal Medicaid Enrollment

23%

18%25%

21%

13%

<10,000

10,000-30,000

30,001-50,000

50,001-100,000

100,000

Page 5: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

5

Medicaid SSI EnrollmentMedicaid SSI Enrollment

23%

33%

26%

18%

Don't know

<500

500-5,000

>5,000

SSI Enrollment

Page 6: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

6

Clinical Programs - OverviewClinical Programs - Overview

98% of plans have special clinical programs for 98% of plans have special clinical programs for Medicaid enrolleesMedicaid enrollees

Most (87%) have programs for MCH population Most (87%) have programs for MCH population or asthma/ diabetes disease management.or asthma/ diabetes disease management.

More than half (61%) have programs for some More than half (61%) have programs for some portion of SSI populationportion of SSI population

Page 7: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

7

General Categories of ProgramsGeneral Categories of Programs

Disease ManagementDisease Management

Intensive Case ManagementIntensive Case Management

General Case ManagementGeneral Case Management

Behavioral Health ProgramsBehavioral Health Programs

Page 8: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

8

Disease Management ProgramsDisease Management Programs

Asthma 59% Diabetes 49% CHF/Cardiovascular 20% Pregnancy 20% Hypertension 11% Sickle cell 10% HIV/AIDS 8% COPD 7%

Page 9: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

9

Case Management ProgramsCase Management Programs

Pregnancy/high risk 44% Children with special health care needs 25% HIV/AIDS 23% Serious mental illness 17% Physical disability/rehab/DME users 16% Transplants 16% Developmental disability 8%

Page 10: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

10

Special Behavioral Health ProgramsSpecial Behavioral Health Programs

Only half of the plans receive the Medicaid Only half of the plans receive the Medicaid capitation for behavioral healthcapitation for behavioral health

Of these, 59% carve-out behavioral health services Of these, 59% carve-out behavioral health services to a BHOto a BHO

Half of the plans report special mechanisms to Half of the plans report special mechanisms to coordinate behavioral and physical health servicescoordinate behavioral and physical health services

Page 11: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

11

Special Behavioral Health ProgramsSpecial Behavioral Health Programs

10 plans described a special behavioral health 10 plans described a special behavioral health program for one or more of the following program for one or more of the following populations:populations:

People with serious and persistent mental illness Children with serious emotional disturbances People with developmental disabilities People with physical disabilities

Page 12: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

12

Detailed Program DescriptionsDetailed Program Descriptions

51 plans51 plans 18 states18 states 71 programs71 programs

– 46 programs for MCH population, asthma or 46 programs for MCH population, asthma or diabetes case management, hypertensiondiabetes case management, hypertension

– 20 programs for SSI population or some 20 programs for SSI population or some portion, special needsportion, special needs

– 5 programs for COPD or cardiac disease mgmt.5 programs for COPD or cardiac disease mgmt.

Page 13: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

13

20 Plans With Programs for SSI20 Plans With Programs for SSI

SSI population SSI population 5 plans5 plans Chronically ill, special needs populations Chronically ill, special needs populations 5 plans5 plans Children with special health care needs Children with special health care needs 4 plans4 plans Frail elders Frail elders 3 plans3 plans HIV HIV 3 plans3 plans Sickle cell, physical disability, CHF Sickle cell, physical disability, CHF 2 plans 2 plans Morbidly obese, rehabilitation, transplants, wound care, Morbidly obese, rehabilitation, transplants, wound care,

foster children, COPD ( 1 plan each)foster children, COPD ( 1 plan each)

Page 14: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

14

Referral SourcesReferral Sources

00.10.20.30.40.50.60.70.80.9

Risk Assess Provider SelfReferral

Database Other

SSI/CI MCH/asthma

Page 15: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

15

Case Management FunctionsCase Management Functions

0%10%20%30%40%50%60%70%80%90%

100%

Care Plans Home Visits AuthorizeBenefits

CaseConference

SSI/CI MCH/asthma

Page 16: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

16

Other Program FunctionsOther Program Functions

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Transport Coordinate BH 24 Hour Access New Benefits Crisis Int.

SSI/CI MCH-asthma

Page 17: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

17

Special Provider RelationshipsSpecial Provider Relationships

0%5%

10%15%20%25%30%35%40%

Primary Care Hosp. Clinic Specialist DurableMedical

BehavioralHealth

SSI/CI MCH/asthma

Page 18: Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Medicaid Working Group - Boston University School of Public Health

18

Program ObstaclesProgram Obstacles

0%

5%

10%

15%

20%

25%

30%

ResourcesData

Patient Compliance

Finding patients

Provider practice

Cost Effe

ctiveness

BH Carveout

SSI/CI MCH/asthma


Medicare-Medicaid Linked Enrollees Analytic Data Source … · 2019-09-13 · service-level analytic files that are part of the Medicare-Medicaid Linked Enrollee Analytic Data Source

Medicare-Medicaid Linked Enrollees Analytic Data Source … · 2019-09-13 · service-level analytic files that are part of the Medicare-Medicaid Linked Enrollee Analytic Data Source

Appendix A Federal Medicaid Waivers · Medicaid Model: Approximately 90 percent of Medicaid enrollees are in managed care. The remaining 10 percent includes Native Americans and emergency

Appendix A Federal Medicaid Waivers · Medicaid Model: Approximately 90 percent of Medicaid enrollees are in managed care. The remaining 10 percent includes Native Americans and emergency

ACOs & Chronic Care Management: Opportunities For ... · 55% of Medicaid enrollees, and 64% of Medicare enrollees did not receive follow-up care within seven days of discharge from

ACOs & Chronic Care Management: Opportunities For ... · 55% of Medicaid enrollees, and 64% of Medicare enrollees did not receive follow-up care within seven days of discharge from

Understanding Changes to Medicaid Behavioral Health Care ... · June 2016. 24. When do these changes happen? Medicaid Managed Care enrollees who live outside of New York City •

Understanding Changes to Medicaid Behavioral Health Care ... · June 2016. 24. When do these changes happen? Medicaid Managed Care enrollees who live outside of New York City •

Monica F. Anderson, DDS - National Dental Association · Medicaid Dental Benefits Medicaid covers dental services for all child enrollees (age 18 and younger) as part of a comprehensive

Monica F. Anderson, DDS - National Dental Association · Medicaid Dental Benefits Medicaid covers dental services for all child enrollees (age 18 and younger) as part of a comprehensive

Overdose Deaths among Medicaid Enrollees in … 2 Overdose Deaths among Medicaid Enrollees in Washington State The Role of Behavioral Health Needs DSHS • Medicaid enrollees are at

Overdose Deaths among Medicaid Enrollees in … 2 Overdose Deaths among Medicaid Enrollees in Washington State The Role of Behavioral Health Needs DSHS • Medicaid enrollees are at

Chapter 1: Mandatory and Optional Enrollees and Services ...Mandatory and Optional Enrollees and Services in Medicaid Key Points • Medicaid is a partnership between the federal government

Chapter 1: Mandatory and Optional Enrollees and Services ...Mandatory and Optional Enrollees and Services in Medicaid Key Points • Medicaid is a partnership between the federal government

Medicare-Medicaid Enrollees: An Examination of New ... · Medicare-Medicaid Enrollees: An Examination of New Maryland Enrollees and Pathways to Coverage November 14, 2012 Donna Folkemer,

Medicare-Medicaid Enrollees: An Examination of New ... · Medicare-Medicaid Enrollees: An Examination of New Maryland Enrollees and Pathways to Coverage November 14, 2012 Donna Folkemer,

Medicaid and Medicare Enrollees Need Dental, Vision, and ...

Medicaid and Medicare Enrollees Need Dental, Vision, and ...

Barriers to Tobacco Cessation Treatment in State Medicaid ... · Barriers to Tobacco Cessation Treatment in State Medicaid Programs Medicaid enrollees are twice as likely to smoke

Barriers to Tobacco Cessation Treatment in State Medicaid ... · Barriers to Tobacco Cessation Treatment in State Medicaid Programs Medicaid enrollees are twice as likely to smoke

STATES MOVE TO IMPLEMENT MEDICAID WORK …...Engagement Requirements for Some Adult Medicaid Enrollees as a Condition for Continued Medicaid Eligibility or Coverage, 2018. *Federal

STATES MOVE TO IMPLEMENT MEDICAID WORK …...Engagement Requirements for Some Adult Medicaid Enrollees as a Condition for Continued Medicaid Eligibility or Coverage, 2018. *Federal

Introductory Webinar Nationwide CAHPS Survey of Adult Medicaid Enrollees ***UPDATED*** 9/8/2014 with new guidance from CMS.

Introductory Webinar Nationwide CAHPS Survey of Adult Medicaid Enrollees ***UPDATED*** 9/8/2014 with new guidance from CMS.

MEDICAID ENROLLEES NEED CLINICAL TRIAL ACCESS

MEDICAID ENROLLEES NEED CLINICAL TRIAL ACCESS

Florida Medicaid: Managed Care Rate Settingahca.myflorida.com/medicaid/recent_presentations/House... · 2017-01-11 · Managed care is when health plans manage how their enrollees

Florida Medicaid: Managed Care Rate Settingahca.myflorida.com/medicaid/recent_presentations/House... · 2017-01-11 · Managed care is when health plans manage how their enrollees

Web viewPitkin County tops the list with an increase of 177 percent, growing from 447 Medicaid enrollees in 2013 to 1,240 enrollees in 2014. Indeed,

Web viewPitkin County tops the list with an increase of 177 percent, growing from 447 Medicaid enrollees in 2013 to 1,240 enrollees in 2014. Indeed,

Medicaid Adult Core Measures Set...Medicaid Adult Core Measures Background In an effort to improve the quality of services provided to Medicaid enrollees and to increase transparency

Medicaid Adult Core Measures Set...Medicaid Adult Core Measures Background In an effort to improve the quality of services provided to Medicaid enrollees and to increase transparency

Medicaid Managed Care Transparency Report · During State Fiscal Year 2016, more than a million Louisiana Medicaid and Louisiana hildren’s Health Insurance Program (LaCHIP) enrollees

Medicaid Managed Care Transparency Report · During State Fiscal Year 2016, more than a million Louisiana Medicaid and Louisiana hildren’s Health Insurance Program (LaCHIP) enrollees

FACTORS PREDICTING TRANSITIONS FROM MEDICARE-O … · MME Medicare-Medicaid Enrollee SNF Skilled Nursing Facility . 1 . INTRODUCTION . Medicare-Medicaid enrollees (MMEs) are older

FACTORS PREDICTING TRANSITIONS FROM MEDICARE-O … · MME Medicare-Medicaid Enrollee SNF Skilled Nursing Facility . 1 . INTRODUCTION . Medicare-Medicaid enrollees (MMEs) are older

Center for Medicare and Medicaid Innovation - …...Minnesota requires Medicaid managed care enrollment for most Medicare-Medicaid enrollees; MSHO provides an integrated alternative

Center for Medicare and Medicaid Innovation - …...Minnesota requires Medicaid managed care enrollment for most Medicare-Medicaid enrollees; MSHO provides an integrated alternative

NON-EMERGENCY MEDICAL TRANSPORT of NASSAU & SUFFOLK COUNTY FEE-FOR-SERVICE MEDICAID beginning July 1, 2015 and MANAGED MEDICAID ENROLLEES beginning on.

NON-EMERGENCY MEDICAL TRANSPORT of NASSAU & SUFFOLK COUNTY FEE-FOR-SERVICE MEDICAID beginning July 1, 2015 and MANAGED MEDICAID ENROLLEES beginning on.