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Zerwas tx mcd aco
Zerwas tx mcd aco
Zerwas tx mcd aco
Zerwas tx mcd aco
Zerwas tx mcd aco
Zerwas tx mcd aco
Zerwas tx mcd aco
Zerwas tx mcd aco
Zerwas tx mcd aco
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  • 1. American Academy of Family Physicians2011 State Legislative Conference Representative John Zerwas, M.D. Texas House of RepresentativesChair-Appropriations Subcommittee on Health and Human Services 1
  • 2. State General Revenue Spending By Article: FY 2000 and FY 2010FY 2000 State GR Spending by Article, FY 2010 State GR Appropriation by Article, Total Spending = $27.3 billion Total Appropriated = $42.4 billion General General Government/Other Government/Other Public Safety and $2.6 billion $1.7 billion Criminal J ustice Public Safety and $4.3 billion 6% 6% Criminal J ustice $3.3 billion 12% 10%Health and Human 20% 62% 56% Education 28% Services Health and Human $23.5 billion Education $5.6 billion Services $16.8 billion $12.0 billion Source: Legislative Budget Board, Fiscal Size-Up, 2010-2011 Biennium; 2002-2003 Biennium State General Revenue Amounts do not adjust for American Reinvestment and Recovery Act (ARRA) funds in FY 2010 2
  • 3. Historical State & Federal Medicaid Spending Total Federal and State Medicaid Client Services Spending (millions) 1981 1991 2001 2011 Federal Client Services $688.6 $2,350.2 $6,234.1 $16,146.3 Payments ($Millions) $20,000.0 State Client Services $493.5 $1,333.6 $4,024.4 $8,550.1 $16.1 Payments ($Millions) B $16,000.0 Total Spending ($Millions) $1,182.0 $3,683.7 $10,258.5 $24,696.4 Federal Spending $12,000.0(millions) $8.6B $8,000.0 State Spending $4,000.0 $0.0 1981 1991 2001 2011 3
  • 4. Where Texas SpendsMedicaid Dollars – Caseload 4
  • 5. Where Texas Spends Medicaid Dollars – Services * T exas Medicaid Expenditures, SFY 2009 By Service Type — Total $22.9 billion Long T erm Prescription Services and Supports Drugs $5.2 billion $2.0 billion Delivery Supplemental 24% 9% Payments to H MOs Medicare $0.3 billion Parts A, B & D Dental $1.3 billion $1 billion 4% Disproportionate Supplemental Share H ospital 24% Program Payments $1.7 billion $5.4 billion Physician 17% Upper Payment& Professional Limit $4 billion $2.0 billion 9% 14% * Source: Medicaid Management Information System (MMIS). H ospital & H ospital Inpatient Prepared By: Office of Strategic Decision Support, Financial Services, Clinic Outpatient Texas Health and Human Services Commission, J 2010. une $3.3 billion $2.1 billion N ote: Due to rounding, totals may not add up exactly. 5
  • 6. Where Texas SpendsMedicaid Dollars – Providers 6
  • 7. SB 7 Initiatives• Purpose of legislation – Improve the administration, quality, and efficiency of Texas health care benefits. – Allows Medicaid managed care expansion into the Cameron, Hidalgo, and Maverick counties. – Carves prescription drugs into managed care organization plans, including the use of vendor drug program formularies. – Study physician incentives to reduce non-emergent use of emergency rooms and implement recommendations if found cost effective. – Cost sharing requirements to improve appropriate program utilization. – Creates a Quality-Based Payment Advisory Committee. – Establishes the Texas Institute of Health Care Quality and Efficiency. 7
  • 8. SB 7 Initiatives– Requires development of quality-based outcome and process measures.– New quality-based payment systems for: • Managed care • Home health • Hospitals– Develop alternative health care delivery systems that promote health care coordination and provider collaboration. • Establishes health care collaborative guidelines and support • Texas Legislature encourages health care provider collaboration to improve transparency, create greater accountability, and promote innovation. – The new procurement of the managed care contracts will specify these objectives. 8
  • 9. SB 7 Initiatives– Encourages cost-savings by implementing and identifying: • Alternative payment systems – Blended – Episode-based bundled – Global • Potentially preventable – Admissions – Ancillary Service – Complications – Readmission • Payment Incentives for – High-quality, cost-effective healthcare – Evidence-based best practices 9

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