Magellan`s Medicaid Experience

Report
NYAPRS EXECUTIVE SEMINAR
April 28, 2011
Empire State Plaza, Albany
Magellan’s Medicaid Experience
Public sector focus - 60% of Magellan’s Revenue is Medicaid
Manage behavioral health care for 1.5 million Medicaid members for 8
health plans in 12 States through subcontracting agreements
Contract directly in 5 states representing 13 contracts (Arizona, Florida,
Pennsylvania, Iowa, and Nebraska), for 1.9 million members
Pharmacy Benefits Administration Experience in 25 States and
DC
Magellan Health Services, Inc. | 2
Magellan: Medicaid Expertise
All public sector programs are unique but leverage core
competencies:
 Resources & Experience – Dedicated public sector teams working locally
in each State; national experts who provide implementation expertise and
ongoing technical assistance/support.
 Infrastructure – Specialized BH IT, claims and QI technologies
customized for State and Health Plan customers. Focus on outcomes for
members and families.
 Flexibility- understanding of the unique needs of each State; customized
clinical and provider initiatives that address service gaps.
 Dynamic Service Array – Track record expanding and enhancing local
service delivery systems to focus on community-based programs, peer
support, wraparound services and services that promote recovery goals.
 Partnership – Collaborative program design and oversight models that
engage consumers, family members, providers and other stakeholders in
the decision-making process.
 Integration – Coordinated approach to physical and behavioral health,
including holistic treatment planning and medication management.
Magellan Health Services, Inc. | 3
Experience with ACO-Like Models
Key elements in behavioral health approach to
ACOs/Health Homes:
 Experience working with persons with SMI; assisting individuals to
manage their behavioral health symptoms
 Experience coordinating and managing the care of persons with a
mental health or both mental health and substance abuse diagnosis;
and physical health/medical diagnosis
 Co-location of behavioral health teams with health plans or MCOs
 Data sharing within and across systems to create recipient profiles
 Partnering with State customers utilizing Section 2703 of the PPACA:
o A state may amend its Medicaid plan to provide for medical assistance to
individuals with chronic health conditions who select a provider or health
team as the individual's "health home" for the provision of home health
services.
o During the first two years that the State Medicaid Plan amendment is in
effect, the federal medical assistance percentage or "FMAP" (the federal
government's share of a State's expenditures for Medicaid) is 90%.
Magellan Health Services, Inc. | 4
Examples of ACO-Like Models
 Maricopa County, Arizona:
o Global payments to Provider Network Organizations (PNOs) who are
accountable for individual and program outcomes:
o Publicly-available on-line ‘dashboards’ promote PNO transparency and
accountability
 Florida:
o Sub-capitated payments for outpatient care provided to enrollees in the
Prepaid Mental Health Plan (PMHP)
Magellan Health Services, Inc. | 5
Behavioral Health Approaches & Savings
 Savings can be achieved through care management approaches
Magellan has achieved savings without reducing outpatient provider rates by use
of peer programs and community supports diverting members from emergency
rooms and reducing inappropriate admissions to inpatient care
o
 Savings can be achieved while meeting recovery and wellness objectives, and
meeting quality improvement goals
 Continuous care management efficiencies within mature Medicaid programs
o
Field care management (6% savings on cost of care in a mature program)
o
Targeted efforts in 2 mature programs (5-6% savings on cost of care)
•
Reduce readmissions
•
Decrease inpatient lengths of stay
•
Decrease residential treatment utilization
•
Reduce admission to inpatient care
Magellan Health Services, Inc. | 6
Collaborating with Providers to Improve Performance
 Provider Dashboard
o
Increase provider accountability and performance
o
Measure key indicators designed to improve recipient outcomes
o
Data shared via Web – electronic provider benchmarking improves care while
incurring minimal costs
 Performance-based Contracting (PA)
o
Reward for quality – varies by provider based on level of care
o
Reduce ALOS, improve outcomes while containing costs
 Reward for Quality (IA)
o
Providers with demonstrated positive outcomes subject to less frequent
review/oversight
o
Reduces administrative burden on providers, while promoting and leveraging
provider best practices
Magellan Health Services, Inc. | 7
IHH: A Comprehensive Solution
Integrated health homes featuring behavioral health providers as the
clinical lead for care
 Persons with SMI and co-morbid conditions are best served in a BH centered
IHH due to unique capabilities and expertise required to treat persons with
SMI
 Creative and innovative uses of health information technology
o
Integrated member service record
o
Comprehensive view of member’s past and current medical, behavioral, and
pharmacy services
o
More efficient and streamlined coordination of health services
 Superior anticipated outcomes
o
Improved clinical indicators
o
Better experience of and satisfaction with care
o
Cost savings through reduced ER visits, hospitalizations, and re-admissions to
intensive levels of care
Magellan Health Services, Inc. | 8
Barriers to Care Coordination
Primary
Care
Behaviora
l Health
Clinical gaps in
care
Difficulty
keeping primary
care and bh
visits
Issues with
transportation
More likely to die
by suicide
78%
Unemployed
At least 75%
smoke tobacco
Substance
Abuse
Issues with
literacy and
health literacy
Likely to die 25
to 30 years
younger
15% have
diabetes
40 – 60% of
those with
schizophrenia are
overweight
Surrounded by
others with
similar issues
Very low Income
/ poverty
Physician’s offices
often not set up to
care for individuals
with SMI
Specialists
Anxiety from
unaddressed
physical issues
ER/Urgent Care
High prevalence
of co-morbidities
Difficulties with
medication side
effects and
adherence
INDIVIDUAL CHALLENGED WITH
MENTAL HEALTH AND/OR
SUBTANCE ABUSE
Hospital
Admission
Magellan Health Services, Inc. | 9
Essential Elements of Integrated Health Home
Overview
1
6
Outcomes
and
accountabilit
y
Enhanced
provider
coordination
/ pharmacy
management
5
Member
engagement,
peer support,
and family
support
 Behavioral health is the gateway to
improved health outcomes through this
model, leveraging expertise in utilizing
peer support, community resources
and telemedicine.
1
2
3
2
Use of
community
resources
Behavioral
Health as
Lead
Coordinato
r
3
Provision of
basic physical
health
services
Increased
access to
care,
including use
of
telemedicine
 Basic primary care functions are
administered via the BH team, whether
in a CMHC or other BH clinic setting. 4
 The BH lead also coordinates more
intensive medical care, including
specialists and follow-up from hospital
care. 5
4
Specialty
Care
Hospital
Care
 Patient registry tools track outcomes
6
and drive accountability.
Magellan Health Services, Inc. | 10
PA HealthChoices/HealthConnections Case Study
Value
Proposition
“ Develop a best practice in which a behavioral health carve-out (Magellan) and a Medicaid
physical health plan in southeastern PA partner together to improve the connection and
coordination of care for adults with serious mental illness enrolled in the HealthChoices
Medicaid program. “

Serves Medicaid adults diagnosed with schizophrenia, mood disorder, or borderline
personality disorder
Two-year pilot program established and monitored by the Pennsylvania Department of
Public Welfare
Services include integrated member profile, including pharmacy data, for participants;
multiple clinical touch points between physical and behavioral system; community-based
‘navigators’ who facilitate tx coordination
Program
Summary

Desired
Outcomes



Decreased inpatient admissions and ER visits
Member service profile and integrated health/wellness plan developed for each member
Timely notification to prescribers about medical refill gaps

Improved coordination of care:
100% of members connected with PCP
100% of members connected with appropriate behavioral health services
89% made or sustained progress meeting substance abuse recovery goals
93% of participants connected to a medical specialist
Utilization changes:
BH outpatient utilization increased,
ER and inpatient utilization for physical health decreased
Preliminary
Results


Magellan Health Services, Inc. | 11
Magellan’s Peer Initiatives
Peer experience is valued and integrated at all levels of our Public
Sector programs
o
Peer specialists work in our care management centers and national team
o
Peer-provided services and supports through our provider network
o
Partnerships with peer-operated organizations in communities we serve
o
Promotion of mutual self-help and support groups as a vital resource for
recovery
Peer Support as an evidence-based practice is implemented
through approaches that work
o
o
o
o
Peer Crisis Navigators help link people to services to prevent ongoing crisis
involvement (AZ)
Peer Connections and other bridger-type programs help people coming out of
hospitals (PA and FL)
Peer specialists trained to provide crisis support (IA)
Peer Support Whole Health – rolling out across all Public Sector programs.
• Currently in place in Maricopa, Pennsylvania, and Iowa.
Magellan Health Services, Inc. | 12
Recovery, Resiliency & Wellness Initiatives Promote Improved Outcomes
 Peer Support Whole Health initiative promotes individual success in
achieving personal health goals
o
Participants set goals to address specific health/wellness issues
o
Targeted education sessions and activities (walking clubs, phone trees for smoking
reduction, relaxation and stress groups) to assist participants in meeting their goals
o
Services billable to Medicaid as peer/family support, living skills, health promotion
 Passport to Care
o
Educates recipients on importance of physical health care, prevention
o
Tools and techniques to assist recipients in talking with their PCP, sharing critical BH
information such as pharmacy and labs
 Continuing commitment to implement across all Public Sector
programs
o
250+ peer specialist trained in PSWH in partnership with Appalachian Consulting
Group since 2009
o
Peer Support Whole Health part of Integrated Health Home pilots
o
Expect an additional 150 peer specialists to be trained this year
Magellan Health Services, Inc. | 13
Recovery, Resiliency & Wellness Initiatives Promote Improved Outcomes
 Arizona Smokers’ Helpline (ASH)
o
Provides Medicaid recipients with free telephonic and on-line resources to stop
smoking, which in turn improves overall health outcomes
o
Includes “Personalized Quit Plan” to help participants meet their smoking
cessation goals
o
Resources available in Spanish and English
 Peer Crisis Navigators
o
Implemented in 2010 in Maricopa County – links individuals in crisis to community
outpatient treatment
o
Used as both step down and diversion
o
Peer navigators assist those in need, break cycle of repeat crisis episodes
o
Contract with a peer organization to provide warm line service
Magellan Health Services, Inc. | 14
Recovery, Resiliency & Wellness Initiatives
 Youth in Transition - Magellan Youth Leaders Inspiring Future Empowerment
(MY LIFE) – AZ, PA
o
o
o
Awardee at NMHCC National Convention 2011
Youth-led initiative in which young people develop their own service solutions
Improves the systems of care for youth in transition
 www.magellanofaz.com website – extensive tools and resources
o
o
Recovery and Resiliency learning center – 10 webinars on diverse
recovery/resiliency topics; four webinars on Peer Support
Outcomes dashboard showing program performance in key areas
Magellan Health Services, Inc. | 15
Recovery, Resiliency & Wellness Initiatives
 Self Directed Care
Persons with SMI (Iowa)
o

Person-centered planning, life coaching, individual budgeting, financial management,
expanded provider networks and services

Participants work within a “budget” to “purchase” both traditional Medicaid services and
other, non-traditional goods and services that support their recovery and resiliency plans
Families with Children with Autism (Pennsylvania)
o

Children with a diagnosis along the autism spectrum and their families received funds to
purchase products and services not otherwise covered by insurance

Funds used for activities to encourage interaction with family members/peers. Other
families purchased computers and other media to increase their child’s communication
skills

Families empowered to take leadership role in their own treatment process
 Children’s System of Care
o
o
o
o
Goal: Maintain at-risk children with families/caregivers, in their communities
Care coordinated by dedicated clinicians with expertise in children’s issues
Access to a range of specialized child/family resources
Joint treatment planning with schools, medical providers, families, caregivers
Magellan Health Services, Inc. | 16
Homeless/Housing Initiatives
Since 2007, Magellan has facilitated addition of 3,911 new units of subsidized and
transitional housing in Maricopa County, AZ – an increase of 15% in total units available

Participation in Maricopa County Continuum of Care on Homelessness Committee:
o
o
o
o

Housing and Urban Development (HUS) Point-in-Time Homeless Count:
o
o
o
o

Multi-agency committee that includes Government representation, agency members,
formerly homeless individuals and advocates
Committee develops strategies to access Federal and local HUD funds
Magellan provides dollar-for-dollar match in the form of case management, wraparound
services to support housing initiatives
Also provides technical assistance in development and submission of renewal/new grant
applications
Federally-mandated point-in-time survey to gather data on numbers, characteristics of
homeless individuals
Magellan staff volunteer time to participate in annual survey
Survey data used to justify additional funding requests, prioritize housing development
Includes sub-survey that profiles homeless and chronically homeless veterans
Project Homeless Connect:
o
o
o
Monthly ‘one-stop shop’ that provides immediate access to an array of social and support
services to homeless/chronically homeless individuals
Behavioral health assessment and crisis evaluations with clinical professionals
Provided in partnership with local provider agencies that specialize in services to homeless
individuals
Magellan Health Services, Inc. | 17
Homeless/Housing Initiatives

Project for Assistance in Transition from Homelessness (PATH):
o
o
o
o

Bridge Subsidy Program (BSP):
o
o
o
o
o

Partnership with AZ Department of Health Services and Southwest Behavioral Health Services
Outreach for homeless individuals not currently engaged in BH services to help them find
treatment and housing
Quarterly meetings to identify barriers, find solutions to increase housing availability
SAMHSA’s national PATH consultant has provided presentations and program assessment
support
Collaboration between Magellan, Public Housing Authorities (PHAs) and non-profit organizations
Provides linkages and housing for persons with serious mental illness using a Housing Choice
Voucher (HCV) system
Features the Permanent Supportive Housing (PSH) model (a national best practice) that
provides permanent housing, typically rentals, for members.
The BSP provides transitional funding to help eligible recipients until they can apply for HUD’s
Section 8 HCV.
It also applies for additional Section 8 vouchers when they become available
Corporation for Supported Housing, Tempe AZ
o
o
o
Multi-agency collaborative that includes Magellan – Federal stimulus funds used for rent/utilities
Created, funded and implemented 35 units of permanent supported scattered site housing for
chronically homeless individuals
Magellan provides ‘supportive services teams’ to individuals to ensure their ongoing stability
Magellan Health Services, Inc. | 18
Preparing to Become a SNP Provider
We look to NYAPRS and its member providers to provide input, partnership
and guidance during the transition to an SNP system. Areas for consideration
include:
PCP/Specialty Health Provider Coordination
o
Majority of SNP eligible individuals will have complex care needs, both medical
and behavioral
o
Foster collaborative relationships with PCPs, other specialty systems
o
Co-sponsor meetings with primary care system to establish common
understanding of challenges and potential solutions
Magellan Health Services, Inc. | 19
Preparing to Become a SNP Provider
Clinical Documentation
o
Review existing clinical documentation (initial assessment, treatment plan,
discharge planning documentation) to ensure inclusion of:
•
Coordination with PCP
•
Medication management
•
Recovery and resiliency focus
Technology Competency
o
Develop Readiness for Electronic Medical Record requirements
o
Ensure system has functionality for comprehensive connectivity, data sharing
Magellan Health Services, Inc. | 20
Questions
Magellan Health Services, Inc. | 21

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