Medicaid in a New Era: Proven Solutions to Enhance Quality and Reduce Costs
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Transcript of Medicaid in a New Era: Proven Solutions to Enhance Quality and Reduce Costs
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8/6/2019 Medicaid in a New Era: Proven Solutions to Enhance Quality and Reduce Costs
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PARTNERSHIP TO FIGHT CHRONIC DISEASE
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Rising rates of chronic disease pose a significant and unsustainable
burden on us as individuals and as a nation. Our ability to bend the costcurve sustainably depends upon our ability to improve health in America
by better preventing and managing chronic disease.
Educatethe public about chronic disease and potential solutions
for individuals and communities
MobilizeAmericans to call for change in how governments,
employers, and health institutions approach chronic disease
Challengepolicymakers on the health policy changes that arenecessary to effectively fight chronic disease
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MEDICAID: THE PERFECT STORM
Projected combined state deficit in FY2012 =
$125B
Projected Medicaid spending FY2012 =
$195B
Enrollment to rise 35% over 10 years, including 16Mfrom Affordable Care Act expansion
More than 60% of acute care spending remains infragmented feeforservice system
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THE CHRONIC DISEASE PROBLEM
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Chronic diseasesare the leadingcauses of death
and disability in theUnited States and
account for the vast
majority of healthcare spending.
They affect the
quality of life for 133million Americans
and is responsible forseven out of every
ten deaths in the U.S.
killing more than1.7 million Americansevery year.
Chronic diseasesaccount for morethan 75 cents ofevery dollar we
spend on health carein this country. In
2007, this amountedto $1.65 trillion.
The United States cannot effectively address escalating health
care costs without addressing the problem of chronicdiseases.US Centers for Disease Control and Prevention
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INCREASING DEMANDS ON HEALTHCARE
Cancer
DiabetesHeart Disease
Asthma
$0.83 of every dollar spent in Medicaid goes to treat
highly preventable and manageable chronic diseases
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FOUR KEY AREAS OF OPPORTUNITY
Cool thehot spots
Fill costlygaps
Promotecoordinated
care
Enhance
adherence
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1. COOLING THE HOT SPOTS
Though more than 60 percent of adult Medicaid enrollees
have a chronic or disabling condition........a mere 4 percent of Medicaid enrollees absorb half of all
Medicaid funding.
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Personalizedaction plans
Responsibilityand
accountability
for outcomes
Teambased,coordinated
care that
supports selfmanagement
Integratingwith
community
basedresources
Regularmonitoring
and followup
PROVEN INTERVENTIONS
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2. FILLING COSTLY GAPS
Feeforservice (FFS) System
Gaps in continuum of care
High rate of readmission within 30 days
Disconnect among patients receivingMedicaid and Medicare
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3. ENHANCING ADHERENCE
One in fourAmericans do not
follow directions in
taking medications
3 out of 4 Americans
admit to having not
taken their
medicines asprescribed at some
point9
Nearly twothirds of allmedicationrelated
hospital admissions have
been attributed to poor
adherence
Poor medication
adherence costs more
than $100 billion a year
nationwide
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4. PROMOTING COORDINATED CARE
Pursuing working models incoordinated care
Integrated medical practices Medical home models
Growth in Accountable Care
Organizations Medicaid health plan models
Community Health Teams 10
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SUPPORT IN THE AFFORDABLE CARE ACT
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Medicaid medical homes (section 2703). Enhanced 90percent match for twoyears when adopt (throughstate plan amendment) team based care coordination
Need to get Medicare involved dual eligibles and feeforservice Medicaid.
Innovation Center potential source for partnering.
Waiver process for coordinated longterm care
States need to act now to create care coordinationand prevention infrastructure to manage risingprogram costs
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TURNING THE TIDE
Improving overall health is the bestway to improve our health care costs. 12
The smoking rate of Medicaid recipients is approximately 53
percent higher than in the general US population
Smokingattributable costs to the states under Medicaid were$22 billion in 2004
Medicaid also has a much higher prevalence of obesity thanother health insurance providers and pays more for inpatient
and outpatient services and medication for obese patients
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CAPITALIZING ON OPPORTUNITY
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Adopting evidencebasedcare coordination
throughout the Medicaidprogram has the potential to
save a total of nearly $250Billion over the next decade
Entitlement reformbothMedicare and Medicaid
need to include nationalprogram to prevent chronicdisease and more effective
care coordination. Both havelarge potential savings.
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For more information, please go to:
www.fightchronicdisease.org
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