Click to edit Master title style 1 Medicaid Innovations: Can Managed Care Cut Costs and Improve Value? Mary V. Mason, M.D. Senior Vice President and Chief Medical Officer Alliance for Health Reform Panel Briefing October 28, 2011
Mar 27, 2015
Click to edit Master title style
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Medicaid Innovations: Can Managed Care Cut Costs and Improve Value?Mary V. Mason, M.D.Senior Vice President and Chief Medical Officer
Alliance for Health Reform Panel BriefingOctober 28, 2011
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1.6 million members
• Children
• Women who are pregnant
• Adults
• Foster care
• Long-term care programs
72% of our members are 18 years old or younger
Our Members
0-18 Years old
18+ Years old
0-18 Years old
18+ Years old
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• Prenatal and postpartum care
• Respiratory ailments
• Diabetes
• Cardiac disease
• Mental illness
• Sickle cell disease
• Rare diseases
• Lack of health and wellness education
Significant Health Issues Face Our Medicaid Members
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Aligning Resources for Treatment
Commonality
Resources
Less Demand
Greater Demand
More rare conditions often demand more resources, whereas more common conditions can be managed with fewer resources
HemophiliaSickleCell
HIVPainMgmt
RSVPrevention
DMADHDAsthmaPregnancyImmunizations
More Common
Less Common
Cardiac
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Plan Process to Improve Medicaid Member Health
Comprehensive approach to combating disease
Identification:CentelligenceTM
Identification:CentelligenceTM Develop Strategy
For Results
Develop Strategy For Results Execution
Execution Measuring Outcomes
Measuring Outcomes
• Predictive modeling• Provider profiling• Quality gaps
• Evidenced-based guidelines• Strong clinical policy• Provider partnerships• Health literacy• Education• Professional organizations
• CentAccount®
• Connections Plus®
• Community relations• Case management• Disease management• Case coordination
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Start Smart for Your Baby®
• We manage the healthcare for more than 70,000 pregnant members each year
• Centene’s comprehensive pregnancy management program
— Wellness and disease management
— Case management/care coordination
• Extends from pre-conception to the first 1-2 years of life of the child
• Early identification is key– Pre-term births are costly – March of Dimes estimates
annual US societal economic burden at $64,000 per pre-term infant*
– Customized predictive modeling software helps identify pregnancy
URAC 2010 Best Practice Platinum Medalist
URAC/GKEN 2010 Best Practice Winner
*Source: March of Dimes, 2008. Dollar amount includes combined newborn and maternal costs.
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Low-birth weight: under 2500g
Low-birth weight: under 1500g
Low-birth weight: under 1000g
7.9 percent fewer
With use of NOP
20 percent fewer
With use of NOP
31.2 percent fewer
With use of NOP
Low Birth Weight Events
38.4%
27.0%
20.0%16.3%
31.2%
6.4%
13.3%7.9%
3.5%
12.8%
0.0%5.0%
10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0%
750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Grams in Weight
Improving Outcomes: Start Smart for Your Baby®
The Notice of Pregnancy (NOP) Is Instrumental in Driving Improvement in Pregnancy Outcomes
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Improving Outcomes: Start Smart for Your Baby ®
More Expectant Mothers are Participating in the Start Smart Program
0%
10%
20%
30%
40%
50%
60%
70%
Jan-0
7
Jul-07
Jan-0
8
Jul-08
Jan-0
9
Jul-09
Jan-1
0
Jul-10
Jan-1
1
Jul-11
Perc
enta
ge o
f D
eliv
eries w
ith a
n N
OP
70%
75%
80%
85%
90%
2008 2009 2010
Tim
eli
ne
ss
of
pre
na
tal
ca
re
45%
50%
55%
60%
65%
2008 2009 2010
Fre
qu
en
cy
of
Vis
its
50%
55%
60%
65%
70%
2008 2009 2010
Tim
eli
ne
ss
of
po
stp
art
um
ca
re
Plans: OH, TX, GA, INHEDIS definitions
•NICU days per 1,000 births dropped from 575 days to 422 days.
•NICU admission rate fell from 4.61% to 3.79%.
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Improving Outcomes: RSV Program
Respiratory Syncytial Virus (RSV) is a major source of respiratory illness in children
• Program Focus
— Education
— Identification
— Responsible utilization of immunoprophylaxis
(Palivizumab)
• Results
— Average length of NICU stay is lower
— 96% compliance with multiple dose therapy
2011 Silver Medalist
2011 Winner
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Improving Outcomes: Hemophilia Program
• 64 unique members enrolled in coordinated program for Hemophilia and von Willebrand’s Disease
— Dosing and assay management— Bleed and infusion monitoring— Education and care management
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New Program to Achieve Better Outcomes: Sickle Cell
Member Population• 1500+ current members with sickle cell,
most < 18 years old• Over 1/3 of the sickle cell members
have had at least 1 ER visit or inpatient stay for crisis in the past 12 months.
• < 50% of members with 3 or more ER visits or inpatient stays for pain crises in the past 12 months have filled a prescription for hydroxyurea.
Treatment with Hydroxyurea• It is recommended to consider
hydroxyurea in ALL sickle cell patients over the age of 15 due to prolonged survival benefits.
Centene’s new sickle cell program will focus on increasing member usage of hydroxyurea and identifying other triggers for pain crises such as uncontrolled asthma
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Observations
•Prevention
•Funding Supporting Strong Investments
•Better Alignment of Federal/State Programs on Rules and Payments
•Coverage (Moms and Post-Partum)