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A Snapshot of the DSS Health Care Transformation Agenda. We are transforming every aspect of how we provide health services to Connecticut residents. 2. We are putting systems in place to help people access services easily and timely . We will be expanding Medicaid eligibility.
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We are transforming every aspect of how we provide health services to Connecticut residents. 2
We are putting systems in place to help people access services easily and timely. We will be expanding Medicaid eligibility. Our partner Administrative Services Organizations are supporting people in using their medical, behavioral health, and dental benefits well and in connecting with providers. 3
We are investing in primary, preventative care. We are working to integrate medical and behavioral health care. We are enabling people who need long-term services and supports to receive them in the community. 4
We are moving to shift from paying for procedures and services, to reimbursing in a way that rewards outcomes. 5
Why are we doing this? Medicaid is a major payer of health services and currently serves over 636,000 beneficiaries (20% of the state population) 4 out of 10 births in Connecticut are to mothers who are Medicaid beneficiaries Under the ACA expansion, Connecticut Medicaid expects to serve approximately an additional 58,000 individuals 6
Why are we doing this? Key health indicators for Connecticut Medicaid beneficiaries, including hospital readmission rates and outcomes related to chronic disease, are in need of improvement 7
Why are we doing this? Connecticut’s health care spending in Medicaid is high compared to other states The $5.12 billion Connecticut Medicaid budget represents a significant percentage of the State budget 8
Why are we doing this? (cont.) 9 Connecticut has: the fourth highest level of health care expenditures at $8,654 per capita, behind only the District of Columbia, Massachusetts, and Alaska the ninth highest level of Medicare costs at $11,086 per enrollee the highest level of Medicaid costs at $9,577 per enrollee [Kaiser State Health Facts, 2009 data]
Why are we doing this? (cont.) Among populations in need, the cost profile for Connecticutindividuals who are dually eligible for Medicare and Medicaid is of particular concern, with per capita costs exceeding the national average by 55% 10
Why are we doing this? (cont.) 2008 data, Kaiser State Health Facts indicate the following about Connecticut’s overall Medicaid-to-Medicare fee index: 11
What is our conceptual framework? DSS is motivated and guided by the Centers for Medicare and Medicaid Services (CMS) “Triple Aim”: improving the patient experience of care (including quality and satisfaction) improving the health of populations reducing the per capita cost of health care 12
We are also influenced by a value-based purchasing orientation. The Centers for Medicare and Medicaid Services (CMS) define value-based purchasing as a method that provides for: Linking provider payments to improved performance by health care providers. This form of payment holds health care providers accountable for both the cost and quality of care they provide. It attempts to reduce inappropriate care and to identify and reward the best-performing providers. 13
How are we doing? Overall expenditures trends are stable NOTE: Monthly variations in expenditures can be attributed in part to differences in the number of claims processing days in a given month, as well as payment adjustments. Overall Medicaid expenditures appear to be stabilizing. The difference between the three month period of March to May 2012 and the most recent three month period of December to February 2013 is an increase of 1.1%
How are we doing? (cont.) There is strong participation in the ASO Intensive Care Management Program. *Medical literature typically cites enrollment rates in care management and disease management programs that range between 7% and 13%
How are we doing? (cont.) *While these results are encouraging, they reflect a very short period of activity targeting the most medically and socially complex of our members; future activity may not sustain this higher level of savings. The ICM function is diverting individuals from inappropriate use of the ED and hospital, and yielding savings.
In conclusion . . . DSS is utilizing diverse strategies to enable access to services, expand eligibility, connect people to primary care, enhance utilization of health care services, integrate medical and behavioral health care, enable services and supports in the community, and shift towards paying for value 21