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June 22, 2005. ALTCI Actuarial Study. Actuarial Study Objectives. Determine key cost drivers Identify financing options that promote the goals of ALTCI Recommend a rate structure that will best match payment to the risk of the enrolled population. Methodology.

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June 22 2005

June 22, 2005

ALTCIActuarial Study


Actuarial study objectives
Actuarial Study Objectives

  • Determine key cost drivers

  • Identify financing options that promote the goals of ALTCI

  • Recommend a rate structure that will best match payment to the risk of the enrolled population


Methodology
Methodology

  • Review historical Medi-Cal and Medicare CY1998-2000 FFS data

  • Adjust data to include only populations and services expected to be covered under ALTCI

  • Project data forward to CY2007 by category of service

  • Adjust data for significant program changes including Medicare Part D


Cy2000 data san diego county
CY2000 DataSan Diego County

  • Nursing Home Residents, MSSP, DD, IHSS, and Home Care (HC) account for 30 percent of the total ALTCI membership in San Diego, but 74 percent of the total San Diego Medi-Cal expenditures.


San diego county cy2000 dually eligible vs medi cal only abd membership
San Diego CountyCY2000 Dually Eligible vs. Medi-Cal OnlyABD Membership


San diego county dually eligible vs medi cal only cy2000 pmpm altci medi cal costs
San Diego CountyDually Eligible vs. Medi-Cal OnlyCY2000PMPM ALTCI Medi-Cal Costs


San diego county elderly vs disabled membership
San Diego CountyElderly vs. Disabled Membership


Alameda contra costa and san diego counties cy1998 2000 medi cal costs high cost chronic conditions
Alameda, Contra Costa, and San Diego CountiesCY1998–2000 Medi-Cal CostsHigh Cost Chronic Conditions


San diego county cy2000 medi cal altci pmpm costs

Total $495

Total

Setting

NH $2,492

Community $303

NHC

$2,492

MSSP

$1,172

IHSS

$752

Well

$182

DD

$436

Frailty

Medicare Status

Medi-Cal Only

$4,708

Medi-Cal Only

$710

Dual

$28

Medi-Cal Only

$368

Medi-Cal Only

$532

Dual

$2,153

Dual

$1,174

Dual

$557

Medi-Cal Only

$1,337

Dual

$277

Aged

$2,291

Disabled

$1,855

Aged

$36

Disabled

$18

Aged

$537

Disabled

$577

Category of Aid

Aged

$196

Disabled

$402

Aged

$3,023

Disabled

$4,910

Aged

$963

Disabled

$1,363

San Diego CountyCY2000 Medi-Cal ALTCI PMPM Costs


Preliminary results key cost drivers
Preliminary ResultsKey Cost Drivers

  • Setting – Nursing Home vs. Community

  • Frailty – Nursing Home Certifiable/At Risk vs. Well

  • Medicare Status – Dually Eligible vs. Medi-Cal Only

  • Category of Assistance – Aged vs. Disabled

  • Chronic High Risk Conditions – TBD


Preliminary recommendations
Preliminary Recommendations

  • Reimbursement needs to be sufficiently sophisticated to promote program goals

  • Incentives should be included to promote increased community based services

  • Savings achievable through more appropriate use of hospital, emergency room and nursing home services

  • Administrative costs should be reflected in rates with sufficient consideration of start up costs

  • Increased care management should be supported and funded


Preliminary recommendations continued
Preliminary Recommendations (continued)

  • Implement early reinsurance or risk sharing

  • Capitated model should allow for flexibility of both Medi-Cal and Medicare funding sources


Next steps
Next Steps

  • Complete projections

  • Assess adequacy of Medicare reimbursement

  • Finalize recommended rating structure

  • Submit final report and recommendations


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