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Spoto & Associates, LLC

Spoto & Associates, LLC. Medicaid Redesign Mike Scribner / Beth Spoto. Spoto & Associates, LLC. National Medicaid Findings.

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Spoto & Associates, LLC

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  1. Spoto & Associates, LLC Medicaid Redesign Mike Scribner / Beth Spoto

  2. Spoto & Associates, LLC National Medicaid Findings As states search for delivery models which decrease cost and provide more benefit, they are focused on efforts to control Medicaid spending for the highest-cost populations. In 2011: Elderly: 8% of the enrollees20% of the cost Disabled: 15% of the enrollees44% of the cost Adults: 27% of the enrollees14% of the cost Children: 50% of the enrollees22% of the cost Source: https://www.hermesdb.net October 2007 to September 2008 data, updated 01/08/2009 ALL OB Services excluded

  3. Spoto & Associates, LLC Georgia is one of the lowest in per capita spending Source: https://www.hermesdb.net October 2007 to September 2008 data, updated 01/08/2009 ALL OB Services excluded

  4. Spoto & Associates, LLC Navigant Options Analyzed nine (9) delivery models; Recommend 3: Option 1: Georgia Families Plus Option 2: Georgia Families Plus – Transitioning to “Commercial Style” Managed Care Option 3: Georgia Families Plus – Transitioning to “Commercial Style” Managed Care Program that requires use of PCMHs and ACOs Source: https://www.hermesdb.net October 2007 to September 2008 data, updated 01/08/2009 ALL OB Services excluded

  5. Spoto & Associates, LLC Georgia Families Plus (expansion of current CMO Program) Includes all Medicaid populations Enrollment of Low-Income Medically Needy Adults & potential Medicaid expansion population. Includes all State Plan Service, including behavioral health Value Based Purchasing Medical Home Use – Encourage use of patient centered medical home (PCMH) model Reduced administrative complexities Wellness Programs Source: https://www.hermesdb.net October 2007 to September 2008 data, updated 01/08/2009 ALL OB Services excluded

  6. Spoto & Associates, LLC Recommended Services to Carve In Behavioral health LTC Services Home and community based waiver services Dental services Transportation services Pharmacy services Source: https://www.hermesdb.net October 2007 to September 2008 data, updated 01/08/2009 ALL OB Services excluded

  7. Spoto & Associates, LLC Option # 2 Commercial Style Managed Care Expands Option #1 by potentially adding the following: Use phased approach to enroll patients in “Commercial Style” plans. Employs all levers/innovations that are used in commercial marketplace, such as deductibles and co-pays. Utilizes copays, deductibles, HRAs, incentive payments, prizes, etc. to encourage healthy behaviors. Source: https://www.hermesdb.net October 2007 to September 2008 data, updated 01/08/2009 ALL OB Services excluded

  8. Spoto & Associates, LLC Option #3 Georgia Families Plus “Commercial Style” Managed Care Program with use of ACOs and PCMHs.

  9. Spoto & Associates, LLC CMO Feedback Little support for carving in long term care. ABD is a done deal. ACO/PCMH concepts valid; Meeting federal definition is not. Use of commercial style patient payment is ineffective and only lowers provider payment. Use of health rewards has been shown to be effective. 3 – 5 CMOs will be approved. All statewide. Source: https://www.hermesdb.net October 2007 to September 2008 data, updated 01/08/2009 ALL OB Services excluded

  10. Spoto & Associates, LLC What are CMO’s looking for? Willingness to move toward gainsharing mechanisms. Quick network development to support RFP response. Complete statewide network. Ability to address overutilization/high costs. Source: https://www.hermesdb.net October 2007 to September 2008 data, updated 01/08/2009 ALL OB Services excluded

  11. Spoto & Associates, LLC Key Strategic Thoughts: More leverage prior to RFP award. More $’s in gainsharing than in FFS negotiations. What’s in it for you to help a prospect? Do you need to contract with all CMOs? Given current history, be smart about language / administrative items as well. Source: https://www.hermesdb.net October 2007 to September 2008 data, updated 01/08/2009 ALL OB Services excluded

  12. Spoto & Associates, LLC Redesign Timeline: I. Assessment August – December 2011. Completed. II. Recommendation January 2012. Posting of the Strategy Report. January – April 2012. Review and analysis of the Strategy Report. April - Summer 2012. Finalization of the Redesign Model. III. Procurement April – July/August 2012. Procurement planning/workgroups ongoing September/October 2012. Procurement documents posted. (RFP issued) 1st quarter 2013. Contract award to successful vendors. IV. Implementation January 2014. Implementation begins. Source: https://www.hermesdb.net October 2007 to September 2008 data, updated 01/08/2009 ALL OB Services excluded

  13. Spoto & Associates, LLC Next Steps? Finalization of redesign model. Ongoing discussions with CMOs Source: https://www.hermesdb.net October 2007 to September 2008 data, updated 01/08/2009 ALL OB Services excluded

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