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2009 ACAP CEO Summit. Controlling Long Term Care Costs and Improving Quality: The Role of Medicaid Managed Care Hank Osowski Senior Vice President SCAN Group July 15, 2009. 2009 ACAP CEO Summit. Controlling Long Term Care Costs and Improving Quality: It’s not your mother’s Medicaid!

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2009 ACAP CEO Summit

Controlling Long Term Care Costs and Improving Quality:

The Role of Medicaid Managed Care

Hank Osowski

Senior Vice President

SCAN Group

July 15, 2009


2009 ACAP CEO Summit

Controlling Long Term Care Costs and Improving Quality:

It’s not your mother’s Medicaid!

Hank Osowski

Senior Vice President

SCAN Group

July 15, 2009


Overview

  • Why Long Term Care Integration is critical

  • SCAN’s experience in California and Arizona

  • Opportunities to meet the challenges


Why Long Term Care Integration

  • State and Federal spending on long term care projected at $3.7 trillion over the next twenty years*

  • Currently fifteen states spend $1 billion or more on long term care; by 2027 twenty-five states will exceed $1 billion in long term care expenditures*

* State Medicaid Expenditures for Long Term Care, Shostak and London, September 2008: Congressional Budget Office estimate


2008

New York - $10.0b

California - $5.6b

Pennsylvania - $3.5b

Ohio - $2.4b

Texas - $2.3b

New Jersey $2.1b

Florida - $1.9b

Illinois - $1.8b

Massachusetts - $1.6b

Minnesota - $1.6b

2027

California - $19.4b

New York - $17.9b

Pennsylvania $7.3b

Ohio - $5.4b

Florida - $5.2b

New Jersey - $4.4b

Minnesota - $4.1b

North Carolina - $2.8b

Illinois - $2.8b

Washington - $2.6b

Top Ten States in LTC Expenditures


Why Long Term Care Integration

  • Elderly (10%) and Disabled (14%) represent a quarter of the Medicaid beneficiaries, yet consume 70% of Medicaid expenditures

  • Long term care, including home and community based services (HCBS), and acute care services each represent about half of those costs


California

109,000 members

6,983 Medi-Cal Dual Eligibles (52% Aged, 40% Long Term Care)

21,000 NHC members

Average age is 78

Arizona

2,700 unique members

2,500 ALTCS (49% are dually enrolled with SCAN)

Average age is 75

SCAN Profile


California Experience

  • Twenty-five years as a Social HMO (intense care coordination model); goal was to maximize members’ independence

  • Provided acute and HCBS services to about 26,000 Medicare beneficiaries

  • CMS discontinued demonstration program December 2007

  • SCAN only Social HMO to continue benefits to members at a cost of about $30 million per year


California Experience

  • Contract with state since 1985 to provide secondary acute care and HCBS services to Dual Eligible beneficiaries

  • 2008 contract expanded to also include custodial care

  • Currently have 6,983 Dual Eligible members; two thirds are long term care

  • Care coordination now mostly telephonic, supplemented with specialty case management for complex cases


California Experience

  • USC Andrus Gerontology Center researchers compared likelihood of transition to the community between SCAN members and Medicare FFS beneficiaries

    • SCAN members spent fewer days in a facility on average (127 vs. 270 days)

    • Significantly fewer SCAN members had stays lasting more than a year (11% vs. 23%)

    • Being a SCAN member increased the odds of transitioning out of the facility by 150%


Geriatric Health Management


Geriatric Health Management


Arizona Experience

  • Awarded ALTCS contract October 2006; began operations with 164 members

  • Parallel development of MAPD Dual Eligible SNP (2007) and MAPD (2008) to coordinate care

  • Currently over 2,500 ALTCS and 1,500 MA members

  • Projected 2009 revenue over $200 million


ALTCS Integration Model

  • Program encompasses full integration of acute care services, HCBS services and custodial care

  • Membership divided among skilled nursing facilities (27%), alternative residential (40%) and home and community settings (33%)

  • Membership ranges from seven years to mid-nineties

    • 62% receive some form of behavioral health

    • HCC Risk Score of MAPD SNP members is 2.012


ALTCS Integration Model

  • Case Management is program cornerstone

  • Began with 14 staff (director, supervisor, ten case managers, a behavioral health coordinator, and an intake coordinator)

  • Case Management staff now at 62 (fifty case managers) and growing

    • Effectively a remote workforce

    • Key forms and assessments are automated

    • Access to all member information in SCAN systems

    • Shared responsibility for 24/7 coverage


Opportunities Abound

  • Current disconnected care model is not sustainable

  • More states seeking solutions to meet long term care challenges and reduce impact on budgets; policy and model development leadership

  • Some federal health reform proposals include additional flexibility and funding for Medicare and Medicaid long term care integration


Questions ??


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