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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
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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.

Mar 27, 2015

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Page 1: 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.

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

Page 2: 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.

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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

Page 3: 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.

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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

Page 4: 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.

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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

Page 5: 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.

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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

Page 6: 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.

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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.

Page 7: 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.

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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

Page 8: 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.

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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%.

Page 9: 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.

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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

Page 10: 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.

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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

Page 11: 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.

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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

Page 12: 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.

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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)