Section 1115 Medicaid Waiver Renewal Safety Net Financing Expert Stakeholder Workgroup #2 Mari...
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Section 1115 Medicaid Waiver RenewalSafety Net Financing
Expert Stakeholder Workgroup #2Mari Cantwell
Department of Health Care ServicesJanuary 12, 2015
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Workgroup Agenda
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Status Update
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Recap of Meeting #1
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Recap of Meeting #1 (continued)
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Bridge to Reform Waiver DSH/SNCP Allocations
Bridge to Reform Waiver DSH/SNCP Allocations
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BTR DSH/SNCP Allocations (DY 10 – FY2014/15 Estimates)
• Current DSH/SNCP allocation methodologies for DPHs:– DSH allocation formula (Estimated Federal Funds: $1,176M)
• Specific allocation amount ($12M)
• Per discharge amounts ($179.7M) :– Medi-Cal: $750 per discharge ($122.6M; 163,465 discharges))
– LIHP: $900 per discharge ($15.8M; 17,506 discharges)
– Uninsured : $1,100 per discharge ($41.3M; 37,577 discharges)
• Remainder allocated using pro-rata distribution based on DSH eligible costs - uncompensated Medi-Cal and Uninsured costs ($984.6M)
– SNCP allocation formula (Estimated Federal Funds: $236M) :• Pro-rata allocation according to SNCP eligible uninsured costs
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Global Budget /Coordinated Care for the
Uninsured
Global Budget /Coordinated Care for the Uninsured
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Key Goals/Concepts
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Methodology
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Methodology (continued)
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Service Categories
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Category 1: Face-to-Face Outpatient Visits
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Category 2: Technology-Based Outpatient Encounters
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Category 3: Non-Office Based Outpatient Encounters
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Category 4: Preventive Health, Education, Care
Management, and Patient Support Encounters
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Category 5: Inpatient/Facility Stays
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Service Categories/Point Valuation
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Hypothetical Example
Hypothetical Example
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Hypothetical Example
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Hypothetical Example (continued)First, establish the “threshold point value” for the system by assigning relative values based on how the current system works and traditional/non-traditional services are or are not reimbursable
Category Service Units Points per Unit Total Points1 Outpatient primary care visit 1,000 10 10,000 1 ER visit 3,000 25 75,000 2 Telephone consultation 500 - - 3 Paramedic treat & release 700 - - 3 Community health worker encounter 500 - - 4 Support group 100 - - 5 Inpatient day 2,500 40 100,000
185,000
Current System/Services (Hypothetical Points)
Threshold Point Value
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Hypothetical Example (continued).Next, after valuing services to recognize high-value of coordinated care and value of non-traditional services, measure total points based on actual services provided in the given year.
Category Service Units Points per Unit Total Points1 Outpatient primary care visit 1,750 20 35,000 1 ER visit 1,750 20 35,000 2 Telephone consultation 1,000 15 15,000 2 Telemedicine 1,000 15 15,000 2 eConsult 300 10 3,000 3 Paramedic treat & release 700 10 7,000 3 Community health worker encounter 750 10 7,500 4 Support group 150 5 750 5 Inpatient day 2,000 35 70,000
188,250
3,250
Future System/Services with Services Valued to Reflect Goals
Total PointsAmount above/
(below) threshold
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Evaluation and Accountability
Evaluation and Accountability
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Evaluation/Accountability
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Evaluation/Accountability (continued)
Resource Allocation – measures of the shift in the balance of carePotential metrics
– Ratio of primary to specialty care visits– Ratio of new to follow-up appointments within specialty care– Average time to discharge from specialty care– Ratio of primary care to emergency room/urgent care visits– Mental health/substance use disorder visits– Inpatient stays related to ambulatory sensitive conditions
Workforce involvement – investment in alternative uses of workforce to expand access and provide higher quality care for lower long term costsPotential metrics
– Use of non-traditional workforce classifications (e.g. CHWs)– Expansion of roles/responsibilities (within scope of practice) for traditional
workforce classifications
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Questions and Discussion
Questions and Discussion
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Key Questions
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Next Steps
Next Steps
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