Vermont’s Dual Eligible project   National Academy for State Health Policy’s 23 rd  Annual State Health Policy Conference ...
Overview <ul><li>Vermont Population Context </li></ul><ul><li>Global Commitment 1115 waiver </li></ul><ul><li>Choices for ...
VT Population context <ul><li>Total state population – estimated 600,000 </li></ul><ul><li>Total Medicare population – est...
Global Commitment 1115 waiver <ul><li>Vermont has a first in the nation Global Commitment 1115 Medicaid waiver  </li></ul>...
Choices for Care 1115 LTC waiver <ul><li>Vermont has a first in the nation 1115 LTC waiver where VT allows a choice of nur...
Governor’s Blueprint for Health <ul><li>Governor Douglas created the Blueprint for Health in Vermont and charged the Vermo...
Vermont is a Medicare plan <ul><li>VT would work with CMS on authority to act as a Medicare plan </li></ul><ul><li>Medicai...
Vermont – data analysis <ul><li>Vermont’s Agency of Human Services has contracted with JEN Associates to assist us with an...
Vermont data analysis - subgroups <ul><li>Analysis of Medicare and Medicaid claims data will be for the following subgroup...
Purpose of data analysis  <ul><li>Create aggregate PMPM for all dual eligibles as well as the 4 cohorts  </li></ul><ul><li...
Vermont is a Medicare plan <ul><li>Model would include expanding upon current Blueprint multipayer effort in Vermont where...
Vermont is a Medicare plan <ul><li>Discuss with CMS: </li></ul><ul><ul><li>State is at risk </li></ul></ul><ul><ul><li>All...
Vermont is a Medicare Plan <ul><ul><li>Discuss with CMS: </li></ul></ul><ul><ul><li>Current and previous discussions with ...
Questions <ul><li>Brendan Hogan, MSA </li></ul><ul><li>Acting Commissioner </li></ul><ul><li>VT Dept. of Disabilities, Agi...
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Vermont’s Dual Eligible project

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Vermont’s Dual Eligible project

  1. 1. Vermont’s Dual Eligible project National Academy for State Health Policy’s 23 rd Annual State Health Policy Conference Brendan Hogan Vermont 10/5/10
  2. 2. Overview <ul><li>Vermont Population Context </li></ul><ul><li>Global Commitment 1115 waiver </li></ul><ul><li>Choices for Care 1115 LTC waiver </li></ul><ul><li>Governor’s Blueprint for Health </li></ul><ul><li>Current project – VT as Medicare Plan </li></ul>
  3. 3. VT Population context <ul><li>Total state population – estimated 600,000 </li></ul><ul><li>Total Medicare population – est. 98,000 </li></ul><ul><li>Total Medicaid & RX population – est. 150,000 </li></ul><ul><li>Total Dual Eligible population – est. 15,000 </li></ul>
  4. 4. Global Commitment 1115 waiver <ul><li>Vermont has a first in the nation Global Commitment 1115 Medicaid waiver </li></ul><ul><li>Waiver includes all Medicaid services except SCHIP and LTC </li></ul><ul><li>http://ovha.vermont.gov/administration/2008-global-commitment-to-health-documents </li></ul>
  5. 5. Choices for Care 1115 LTC waiver <ul><li>Vermont has a first in the nation 1115 LTC waiver where VT allows a choice of nursing home or home and community based services for LTC Medicaid eligibles </li></ul><ul><li>http://www.ddas.vermont.gov/ddas-programs/programs-cfc/programs-cfc-default-page </li></ul>
  6. 6. Governor’s Blueprint for Health <ul><li>Governor Douglas created the Blueprint for Health in Vermont and charged the Vermont Dept of Health to carry out this chronic care management initiative which now involves multi-payer funded pilots in several VT communities </li></ul><ul><li>http://healthvermont.gov/blueprint.aspx </li></ul><ul><li>Governor Douglas created the Blueprint for Health in Vermont and charged the Vermont Dept of Health to carry out this chronic care management initiative which now involves multi-payer funded pilots in several VT communities </li></ul><ul><li>http://healthvermont.gov/blueprint.aspx </li></ul>
  7. 7. Vermont is a Medicare plan <ul><li>VT would work with CMS on authority to act as a Medicare plan </li></ul><ul><li>Medicaid authority would remain with our two 1115 waivers. Duals are in both 1115 waivers </li></ul><ul><li>Financial, data, legal and programmatic analyses are occurring right now for this effort </li></ul>
  8. 8. Vermont – data analysis <ul><li>Vermont’s Agency of Human Services has contracted with JEN Associates to assist us with analysis of Medicare and Medicaid Claims data http://www.jen.com/ </li></ul><ul><li>Claims analysis will include aggregate PMPM analyses for entire population as well as 4 subgroups </li></ul>
  9. 9. Vermont data analysis - subgroups <ul><li>Analysis of Medicare and Medicaid claims data will be for the following subgroups: </li></ul><ul><ul><li>LTC Medicaid </li></ul></ul><ul><ul><li>CRT – Community Rehabilitation and Treatment program (Mental Health) </li></ul></ul><ul><ul><li>Developmental Services </li></ul></ul><ul><ul><li>All other Aged Blind and Disabled </li></ul></ul>
  10. 10. Purpose of data analysis <ul><li>Create aggregate PMPM for all dual eligibles as well as the 4 cohorts </li></ul><ul><li>Apply the HCC – Hierarchical Clinical Classification standards to the data to assist the state in the data analysis and subsequent negotiations with CMS </li></ul><ul><li>http://www3.cms.gov/HealthCareFinancingReview/downloads/04Summerpg119.pdf </li></ul>
  11. 11. Vermont is a Medicare plan <ul><li>Model would include expanding upon current Blueprint multipayer effort in Vermont where existing case management systems for Medicaid would be directly linked to Blueprint Community Health teams </li></ul><ul><li>Better community based coordinated care, we believe, will save both Medicare and Medicaid money and be more effective </li></ul>
  12. 12. Vermont is a Medicare plan <ul><li>Discuss with CMS: </li></ul><ul><ul><li>State is at risk </li></ul></ul><ul><ul><li>All Duals are included </li></ul></ul><ul><ul><li>Passive enrollment with an opt out provision </li></ul></ul>
  13. 13. Vermont is a Medicare Plan <ul><ul><li>Discuss with CMS: </li></ul></ul><ul><ul><li>Current and previous discussions with providers and advocates in Vermont </li></ul></ul><ul><ul><li>Shared savings options </li></ul></ul><ul><ul><li>Health care reform offers opportunities for a model like this to work for both a state and CMS </li></ul></ul>
  14. 14. Questions <ul><li>Brendan Hogan, MSA </li></ul><ul><li>Acting Commissioner </li></ul><ul><li>VT Dept. of Disabilities, Aging and Independent Living </li></ul><ul><li>(802) 241-2401 </li></ul><ul><li>[email_address] </li></ul>

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