Renee Markus Hodin Community Catalyst From Vision to Reality: State Strategies for Health Reform Implementation November 2010 Payment & Delivery System Reform in Medicaid: Opportunities in the ACA

© Community Catalyst 2010 Why Should We Care?

Improve Care For the Most Vulnerable © Community Catalyst 2010

Improve Care for Most Vulnerable (contd) © Community Catalyst 2010 Source: The State of Health Care Quality, 2009, NCQA

Sustain the Medicaid Program © Community Catalyst 2010 Medicaid is: critical to 45 million+ low income and vulnerable people the foundation for and key building block of the coverage expansion in 2014 under enormous fiscal pressure

Sustain the Medicaid Program (contd) © Community Catalyst States plus DC need to close budget gaps Aggregate State Budget Shortfall (FY11) =$121 billion State revenue still below pre-recession levels Continued high unemployment/ growth in poverty drive Medicaid caseload Addl FMAP ending?

© Community Catalyst 2010 Opportunities in the ACA

© Community Catalyst 2010 New Focus on Prevention

Improve Care Coordination © Community Catalyst 2010 Center for Medicare and Medicaid Innovation (2011 & beyond) Federal Coordinated Health Care Office (2010) Medical Homes state option (2011) 90% FMAP for 1 st two years

Explore New Ways to Pay for Care © Community Catalyst 2010 Bundled payments (Oct 2011) 8 states Global payments (FY2010-FY2012) 5 states Pediatric ACOs (Jan 2010 – Dec 2016)

© Community Catalyst 2010 HCBS State Plan Option Expansion (immediate) Money Follows the Person Demonstration Extension (immediate) Community First Choice Option (Oct 2011) State Balancing Incentive Program (Oct 2011) Strengthen Long-Term Care

© Community Catalyst 2010 No federal payments for preventable errors (July 2011) Reduce Medical Errors

© Community Catalyst 2010 Key Takeaways

© Community Catalyst 2010 Key Takeaways 1. Sustaining the Medicaid program is essential work between now and Key to that work is proposing payment & delivery system reforms that improve care while reducing costs (as alternatives to other Medicaid cuts) 3. The ACA includes payment & delivery system reform options, but states must act to take advantage of them – advocates can help!