Connecting Michigan for Health How State Medicaid is Working to Accommodate New Quality Regulations Thomas Curtis Director of Quality Improvement and Program Development Michigan Department of Health and Human Services Connecting Michigan for Health June 9, 2017 Monica Trevino Senior Consultant Health Management Associates

I II IV III All Populations Need Quality Oversight and Now it Needs to Align Overview of Quality Regulatory Landscape in Medicaid Strategy for Quality Requires Collaboration How is Michigan Medicaid Doing This?

Overview of the Medicaid Quality Regulatory Landscape Population Health Maternal/Child Primary Care STATE LEGISLATIVE AND DEPARTMENTAL PRIORITIES Healthy Michigan Plan MI Health Link SIM WAIVERS AND DEMONSTRATIONS Transparency Stakeholder Engagement Alignment CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) RULES HEADLINE FOR BULLET LIST ITEM FOUR

Consistency and transparency are required. All Populations Need Oversight Consistency and transparency are required. CMS has moved toward alignment across plans, programs, and states. States required to set minimum standards, yet maintain flexibility to account for different needs in different states. Every state addresses the same overarching issues, perhaps not in the same way. Public input is required.

A State Quality Strategy Requires Broad Collaboration Comprehensive MDHHS Quality Strategy Medicaid MCOs (MHPs) 11 MCOs--Medicaid, Healthy Michigan Plan, Children’s Special Health Care Services Must include all managed care populations. Integrated Care Organizations (ICOs) MI Health Link Demonstration Behavioral Health MCOs (PIHPs) 10 regional behavioral health managed care organizations Dental Vendor (PAHP) MI Choice Waiver Agents (AAAs) Currently Delta Dental, RFP has been released for a new contract Area Agencies on Aging and other contracted entities

How is Michigan Responding? State Medicaid Agencies Have a Heavy Lift How is Michigan Responding? Data Validation Workgroup Alternative Payment Methodology Workgroup State Innovation Model (SIM) Managed Care Rules Implementation

MSA/HMA Partnership to Implement the Managed Care Rules Managed Care Rule Implementation MSA/HMA Partnership to Implement the Managed Care Rules Engage major program areas (MCPD, BHDDA, MI Choice) Ensure consistency in understanding Implement on a uniform timeline Collaborate with all administrations and programs to get appropriate beneficiary/stakeholder engagement

Workgroup Includes Medicaid Health Plans and QIPD Data Validation Workgroup Workgroup Includes Medicaid Health Plans and QIPD QIPD gives raw data to plans before rates are published or used for performance assessment Plans bump DW rates up against their own administrative data Workgroup discusses any differences Changes made where necessary in queries, definitions, other elements of the process Rerun data for use in QI initiatives

Workgroup Includes Medicaid Health Plans and QIPD Alternative Payment Methodology (APM) Workgroup Workgroup Includes Medicaid Health Plans and QIPD Definition of what constitutes ‘Advanced’ APM, MHPs must meet Plans report medical expenditures by Health Care Payment Learning & Action Network (HCP LAN) categorical framework Workgroup discusses numerator and denominator definitions Plans submit 3-year strategic plan and targets for increasing medical expenditures in advanced categories of APM

Workgroup Includes Medicaid Health Plans and QIPD Alternative Payment Methodology (APM) Workgroup Workgroup Includes Medicaid Health Plans and QIPD APM effort provides framework for department to work collaboratively with Medicaid health plans on payment and care delivery change Unifies Plans and department to engage providers Pursuing standardized quality measures Statewide and by prosperity region to link to APMs Using payment reform as a quality improvement vehicle

SIM Quality Measurement and Medicaid State Innovation Model (SIM) SIM Quality Measurement and Medicaid SIM includes a few custom measures specific to the initiative Also includes standard measures Align with PPQC Align with HEDIS Collaboration with Medicaid health plans Data from DW Warehouse SIM evaluation the same measures but with slightly different methodology

Summary Quality improvement is a priority…and requires a comprehensive approach to do it right. The new Medicaid managed care regulations and CMS grant dollars are leverage to prioritize doing quality improvement the right way. Collaboration with Medicaid health plans and their provider networks is the only way to use credible measurement and incentives to truly improve the quality of care.

CONTACT US Thomas Curtis Monica Trevino Director of Quality Improvement and Program Development Michigan Department of Health and Human Services curtist2@michigan.gov (517) 284-1152 Monica Trevino Senior Consultant Health Management Associates mtrevino@healthmanagement.com (517) 449-1987