Churn continuous eligibility and medicaid the safety net health plan perspective
Download
1 / 9

Churn, Continuous Eligibility, and Medicaid: the Safety Net Health Plan Perspective - PowerPoint PPT Presentation


  • 121 Views
  • Uploaded on

Churn, Continuous Eligibility, and Medicaid: the Safety Net Health Plan Perspective. Georganne Chapin President & CEO Hudson Health Plan Hudson Center for Health Equity & Quality Tarrytown, NY   gchapin@hudsonhealthplan.org July 10, 2009. Overview. An Illustration of the Problem

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Churn, Continuous Eligibility, and Medicaid: the Safety Net Health Plan Perspective' - argus


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Churn continuous eligibility and medicaid the safety net health plan perspective l.jpg

Churn, Continuous Eligibility, and Medicaid: the Safety Net Health Plan Perspective

Georganne Chapin

President & CEO

Hudson Health Plan

Hudson Center for Health Equity & Quality

Tarrytown, NY  

gchapin@hudsonhealthplan.org

July 10, 2009


Overview l.jpg
Overview Health Plan Perspective

  • An Illustration of the Problem

  • Impact on Enrollees

  • Impact on Providers, State Medicaid Programs, and Managed Care Organizations

  • Churn in the Context of Health Reform

  • Solutions: Safety Net Health Plan Action Steps


Churn an illustration of the problem l.jpg
Churn: An Illustration of the Problem Health Plan Perspective

  • Problem: Significant portion (nearly 35%) of Hudson Health Plan’s Medicaid members are involuntarily disenrolled each year.

  • Why? Many lose coverage because of undetected change of address.


Impact on enrollees l.jpg
Impact on Enrollees Health Plan Perspective

  • Individuals and families left vulnerable to illness and injury.

  • Patients experience gaps in ongoing treatments and preventive services.

  • Breaks in coverage cause:

    • Delays and interruptions in care

    • Increased health risks

    • Potential for significant future health problems

    • Poor health!


Impact on providers state medicaid programs and mcos l.jpg
Impact on Providers, State Medicaid Programs, and MCOs Health Plan Perspective

  • Providers: Forced to choose between providing uncompensated care & turning patients away.

  • State Medicaid Programs: Added administrative burden of processing unnecessary disenrollments and enrollments.

  • Medicaid Health Plans: Gaps in critical contact with patients, breaks in care coordination, impaired quality monitoring and improvement activities.


Churn in the context of health reform l.jpg
Churn in the Context of Health Reform Health Plan Perspective

  • Goal of National Health Reform: Universal coverage for all Americans.

    • Constant churn prevents universal coverage.

    • While Senate Finance Committee options document included 12-month continuous coverage mandate for Medicaid,

    • Other proposals silent.

  • Measure and improve health care quality

    • Quality monitoring/improvement required for Medicaid MCOs, but MCOs cover fewer than half of enrollees.

    • No federal requirements for comparable monitoring/improvement for PCCM & FFS enrollees.


Solutions safety net health plan action steps l.jpg
Solutions: Safety Net Health Plan Action Steps Health Plan Perspective

  • Hudson Health has actively worked toward increasing Medicaid continuous eligibility:

    • At the plan-level:

      • Educating members about renewal requirements

      • Streamlined renewal programs

      • Hcheq: FEEA & EnrollNY

    • At the national policy level:

      • Developing Medicaid continuous eligibility policy with ACAP & GW


Questions l.jpg

Questions? Health Plan Perspective