Janet Grant CareSource Management Group Executive Vice President Business Development and Regulatory...
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Transcript of Janet Grant CareSource Management Group Executive Vice President Business Development and Regulatory...
Janet GrantCareSource Management Group
Executive Vice President Business Development and Regulatory Affairs
Medicaid ConferenceSeptember 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
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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…..
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Competencies Required
• Medicare regulatory requirements• Sales/marketing, enrollment• Financial/benefit bid: actuarial expertise• Risk adjustment management• Network development• Pursue state Medicaid integration
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State Challenges
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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
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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
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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
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MI Consumer Education
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Stakeholder Involvement
• Disability advocates – Community Catalyst SNP Consumer Education
Project
• Area Agencies on Aging• Low income housing• Continuing Care Retirement Communities
(CCRCs)
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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
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Current Issues
• SNP reauthorization • State contracting requirement and impact on
service area expansion opportunities• Medicare/Medicaid integration• Identification and education of eligible dual
consumers