New Opportunities for Payment Reform - Minnesota Ross Owen NASHP Annual State Health Policy Conference October 5, 2011

Goals for the Session Provide a quick description of delivery system and payment reforms in Minnesota involving Medicaid Place them in the context of the Affordable Care Act (ACA) Prompt good questions that we can discuss here or after the session 2Ross

Primary Care Reform is Health Reform Health Care Home Initiative – Multi-payer Design and Momentum pre- ACA – Medicare Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration – Sec – Primary Care Provider Rate Increases 3Ross

Toward Accountable Care Medicaid ACO Pilots (Health Care Delivery Systems [HCDS] Demonstration) – Early Lessons Learned Defining “Total Cost of Care” is Different in Medicaid Technical and Data Expertise Required Path to Federal Authority is Uncertain Varying Provider Appetites for Medicaid Risk 4Ross

Model 1: Virtual HCDS Primary care organizations not affiliated with a hospital or integrated system (or any HCDS serving 1,000-2,000 attributed enrollees) Savings achieved beyond the minimum threshold are shared between the payer and delivery system 50/50 5Ross

Model 2: Integrated HCDS Integrated delivery systems providing a broad spectrum of care as a common entity Savings achieved beyond the minimum threshold are shared between the payer and delivery system at pre- negotiated levels Delivery system pays back a pre- negotiated portion of spending above the minimum threshold Ross6

Strategies for Dual-Eligibles Integrated Care for Dual-Eligibles Planning Demonstration – Policy and Data Work to Ensure that these Reforms Work for Duals as Well – Solidifying Managed Care Financing Mechanisms Already Serving Duals in Integrated Special Needs Plans (SNPs) 7Ross

Thank you! 8Ross