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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