1. Michigan Department of Community Health Director Olga Dazzo Michigan’s Plan for Integrated Care National Academy for State Health Policy Kansas City, Missouri October 5, 2011

2. 2 Yontz Michigan’s Health Care Priorities Improve health status of Michigan citizens Improve health care system Lower health care costs Implement provisions of health care reform

3. 3 Yontz Current Environment Medicare and Medicaid spending > $7 billion for 207,000+ duals State spend primarily on nursing facility care and behavioral health services Primarily an older female and younger male demographic Multiple chronic health conditions Data source: 2008 Michigan Medicaid Data Warehouse and ResDAC Medicare Data

4. 4 Yontz Current Environment Managed care physical health and behavioral health systems for Medicaid benefit Little managed care for Medicare benefit Waiting list for long term care HCBS Multiple case managers for people receiving services

5. 5 Yontz Basic Demographics GenderAge Under 65Over 65Total Female64,53971,725136,264 Male55,26830,15585,423 Total119,807101,880221,687 Source: Michigan Medicaid Data Warehouse – 2010 Unduplicated Count of Beneficiaries

6. 6 Yontz Chronic Conditions ConditionNumber of Individuals Percent of Duals Ischemic Heart Disease70,65034% Diabetes64,57031% Depression53,42526% Chronic Heart Failure49,49624% Arthritis48,49123% Behavioral Health41,86320% Alzheimer Related Disease37,87218% Chronic Obstructive Pulmonary Disease36,75418% Chronic Kidney Disease33,05816% Cataract21,85211% Osteoporosis20,06010% Alzheimer’s Disease19,84410% Source: Medicare Chronic Condition Warehouse for 2009

7. 7 Yontz Multiple Conditions Source: Medicare Chronic Condition Warehouse for 2009

8. 8 Yontz Overview of Proposed Approach Provide all covered services for dually eligible beneficiaries through single contracted entity Feature auto-enrollment with opt out Design robust care coordination program with health home and person-centered focus

9. 9 Yontz Overview of Proposed Approach Integrate funds at the state level with full or shared risk/shared savings model Acuity-based capitation arrangement with contracted entities (no pre-selected model) Shared risk initially between Medicaid and contracted entities

10. 10 Yontz Core Program Elements All core Medicare and Medicaid services Comprehensive provider network Single standardized assessment tool Person-centered planning Person-centered health homes Care coordinator or team for each participant Family caregiver involvement

11. 11 Yontz Core Program Elements Strong HCBS options Performance evaluation metrics Quality management strategies and measurements Data sharing to enhance care coordination Auto enrollment with opt out Enrollee protections that meet Medicare and Medicaid standards

12. 12 Yontz Stakeholder Process Informant Interviews Regional Forums Request for Input Topic-Driven Workgroups E-mail box

13. 13 Yontz Things to Think About (or early lessons learned) Prepare for difficult conversations Early data acquisition and analysis Dedicate staff for project planning and development Develop public relations strategy Listen

14. 14 Yontz Contact Information Susan Yontz, Director Long Term Care Services Division Medical Services Administration yontzs@michigan.gov