1. 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

2. 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?

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. CONTACT US Thomas Curtis Monica Trevino
Director of Quality Improvement and Program Development
Michigan Department of
Health and Human Services
(517)
Monica Trevino
Senior Consultant
Health Management Associates
(517)