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Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)
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Medicaid and Public Health: Focus on Asthma (Presented by Stephen Cha, MD, MHS)

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Presented by Stephen Cha, MD, MHS of the Centers for Medicare and Medicaid Services at the annual meeting of the Asthma Regional Council of New England, June 13, 2013, Shrewsbury, MA.

Presented by Stephen Cha, MD, MHS of the Centers for Medicare and Medicaid Services at the annual meeting of the Asthma Regional Council of New England, June 13, 2013, Shrewsbury, MA.

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  • Our policies and regulations should support evidence based interventions that improve the health of our beneficiaries—we should be on the continual lookout for opportunities for our policies to better promote, and also look for ways our policies might be a barrier
    The "what", not the "how"
    Support for an intervention should be guided by the strength of the evidence:
    Promising interventions may be more appropriate for grant programs or further research via CDC or NIH
    Some interventions may have more promise, and may be appropriate for further testing by CMMI or in the context of a waiver or demo
    Other interventions are proven and we should be aggressive in finding ways for our policies to better support these
    We should look to our federal partners to help us in these assessments: CDC, HRSA, SAMHSA, NIH
  • Transcript

    • 1. Medicaid and Public Health: Focus on Asthma Stephen Cha, MD, MHS Chief Medical Officer Center for Medicaid and CHIP Services Centers for Medicare & Medicaid Services June 13, 2013
    • 2. Medicaid and CHIP • The Center for Medicaid and CHIP Services is the nation’s largest insurer: almost 60 million rely on Medicaid and CHIP • 40% of births • One of every four children • Joint state-federal program 2
    • 3. Medicaid Moving Forward • The Center for Medicaid and CHIP Services is working to propel positive change forward to achieve: improved health of populations, improved experience of care, and reduced trends in cost • Goal is comprehensive, integrated patient-centered care and financing that supports these goals • Encourage and support our partners in this effort by clarifying policy and providing support
    • 4. Case study: Assessment and plan 52 year old male • Asthma: Maximal meds already, still with ED visits, needs environmental modification • Diabetes: Meds, counsel on weight and diet • Hypertension: Meds, counsel on weight and diet • Obesity: Counsel on weight and diet • Tobacco: Refer quitline, pt still precontemplative • History of opiate addiction: S/p treatment, in counseling, concerned now that discharged to community • Depression: Meds, therapy at community center • Unstable housing: In housing now
    • 5. Where can public health and prevention resources improve this patient’s health? 52 year old male • Asthma: Maximal meds already, still with ED visits, needs environmental modification • Diabetes: Meds, counsel on weight and diet • Hypertension: Meds, counsel on weight and diet • Obesity: Counsel on weight and diet • Tobacco: Refer quitline, pt still precontemplative • History of opiate addiction: S/p treatment, in counseling, concerned now that discharged to community • Depression: Meds, therapy at community center • Unstable housing: In housing now
    • 6. Problem list for Medicaid and public health together • • • • • • • • Asthma Diabetes Hypertension Obesity Tobacco History of opiate addiction Depression Unstable housing
    • 7. Support Best Practices • Driving question: How are our policies supporting or hindering the best practices on the ground to achieve three part aim? • Strive for seamless set of services across silos– which entity is best situated to most efficiently and effectively achieve our goals? • Medicaid must be a partner in prevention
    • 8. Challenges • Silos: • State level: Medicaid vs public health vs mental health vs chronic disease vs substance abuse vs perinatal • Federal level: Disparate agencies and strategies • Legal/regulatory (i.e., other licensed personnel) • Need for partnerships • Challenges in heading into 2014
    • 9. Lots of mechanisms exist to support Medicaid innovation 1. State plan amendments/waivers –Broad systems reform under 1115: CA, MA, TX, OR –Targeted delivery reforms under waivers: asthma, interconception, LTC –Integrated Care Models (MN) 1. New authorities under Affordable Care Act –Medicaid Quality Measurement Program, health homes, HIT –Adult Quality grants –Others: healthcare acquired conditions, tobacco cessation, prevention, etc. - Section 4106: 1% bump for USPSTF validated services - Section 4004: Education and outreach on prevention, especially obesity 1. Collaboration with Center for Medicare and Medicaid Innovation (CMMI), Medicare-Medicaid Coordination Office (MMCO) –CMMI: State Innovation Models, Strong Start, CPCi, FQHC, chronic disease prevention incentives, emergency psychiatric demonstrations, Innovation challenge grants –MMCO: Financial alignment models 1. Other departmental collaborations: National Quality Strategy, MHI, tobacco
    • 10. Two case study areas for improving public health via Medicaid • Tobacco • Pediatric asthma
    • 11. Tobacco • Quitlines • Pregnant women • Coverage policies
    • 12. Massachusetts Pediatric Asthma Pilot Program • Goal – Improve health outcomes, reduce asthma-related emergency department utilization and asthma-related hospitalizations, and reduce associated Medicaid costs for children with high-risk asthma. • Strategy – Preventative care using CHWs, care teams, and recognition of environmental factors, measured by cost savings and service utilization measures. – PMPM payment • Focus on preventative care – Utilization of non-traditional workers for preventative care • HEPA filters for vacuum cleaners • CHWs for home visits and care coordination – Explicit measurement of cost-shifting vs. cost reduction and effect/interaction of pilot with other state initiatives • Practices are eligible for up to $10,000 in infrastructure payments related to this initiative (may not be implemented)
    • 13. Massachusetts Pediatric Asthma Pilot Program • Reporting Quality to the State – Progress measured by cost savings and service utilization • Post-intervention data compared to baseline numbers – Reduction of ED visits and hospitalizations is primary focus • CHIPRA measure on annual asthma-related emergency room visits is required • State Quality Reporting to CMS – State must provide status updates on a quarterly basis including payment, service, and outcome records
    • 14. Summary: Medicaid on the road to reform • CMS stands ready to partner with states, providers, and stakeholders to accelerate our path to achieve better health, better care and lower costs • Multiple pathways to reform • Driving question should not be our authorities, but the strength of evidence and appropriateness of intervention
    • 15. Questions?

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