Integrating Medicare and Medicaid: Some History and Where We’re Going Ohio HFMA Winter Seminar – Friday, December 12, 2014 Moderator: Jenny Sand, Home.

Integrating Medicare and Medicaid: Some History and Where We’re Going

Ohio HFMA Winter Seminar – Friday, December 12, 2014

Moderator: Jenny Sand, Home Care by Black Stone

Panel: Michael Cebellos, Buckeye Health PlanJan Reed, Molina HealthcareJana Snyder – Provider Services, Molina

Healthcare Deb Jacobs – Health Care Services, Molina Healthcare

Elbony McIntyre – Ohio Department of Medicaid

High-Level History1965 –

Medicare & Medicaid created

1970’s – HMOs offer Medicare

2003 – MMA and Part D

2013 – Medicare-

Medicaid Plan demonstrations

Medicare-Medicaid plans are the first major attempt to modify the existing system since inception.

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Duals Enrollment & Spending

Current spending is unsustainable – change is here to stay. Let’s make MyCare Ohio the best it can be.

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Health Care System Choices

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Demonstration States

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The Opportunity

Ohio was the third state to go-live with the demonstration, and the only to begin with Medicaid passive enrollment.

82 various metrics captured and evaluated by CMS.

What success looks like to be determined through the various state-based demonstration.

We are five months into a 42-month demonstration.

We are creating the future, together.

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MyCare: Ohio’s Medicare/Medicaid Plan

The Demonstration coordinates the physical, behavioral, and long-term care services for individuals over the age of 18 who are eligible for both Medicaid and Medicare. This includes people with disabilities, older adults and individuals who receive behavioral health services

The 42-Month Demonstration, went live in the Northeast region on May 1, 2014. July 1, 2014 saw the last regions go-live.

Of the roughly 182,000 Ohioans covered by both Medicare and Medicaid, as many as 114,000 individuals are expected to be served through the demonstration.

MyCare Ohio enrollees, all of which have Medicaid, will be passively enrolled into Medicare on January 1, 2015; unless a member has chosen to opt-out.

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MissionThe demonstration is a fully capitated program that creates organized systems of care that provide comprehensive services to Medicare-Medicaid enrollees. MyCare Ohio integrates and coordinates healthcare delivery by:

Utilizing managed care to improve care coordination that is patient-centered

Providing one point of contact for beneficiaries

Emphasizing individual choice and control in care delivery

Providing coordination of long-term care services, behavioral health services and physical health services

Supporting an individual’s right to live independently

Reducing the overall cost of care for the beneficiary, Medicaid and Medicare

Providing a seamless transition between settings and programs.

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Complexity to Simplicity

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MyCare Ohio

Medicaid

Behavioral Health

Long-Term Supports & Services

Medicare Part A & B

Medicare Part D

Model of Care – one point of entry into a complex,

priority competing

system

Model of Care

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Model of Care

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• One point of entry into complicated system• Trans-disciplinary team facilitator

Accountable Point of Contact

• Every member conducts a bio-psycho-social assessments

• Integrated care plan and goals

Assessment and Care Plan

• Care Manager meet with member in-patient• Trans-disciplinary team executes discharge

planCare Transitions

• Medicare, Medicaid and assessment information to stratify members into appropriate clinical programs

Clinical Programs

Implementation Timeline

January 1, 2015 – Medicare passive enrollment

December 31, 2017 – Demonstration ends

RegionsRegion Managed Care Plans

Northwest • Aetna • Buckeye

Southwest • Aetna• Molina

West Central • Buckeye• Molina

Central • Aetna• Molina

East Central • CareSource• UHC

Northeast Central • CareSource• UHC

Northeast • Buckeye• CareSource• UHC

9,884

16,225

12,381

6,029

19,456

9,284

37,712

Panel Questions & Answers