Your SlideShare is downloading. ×
Managed Long Term Services
Upcoming SlideShare
Loading in...5

Thanks for flagging this SlideShare!

Oops! An error has occurred.


Introducing the official SlideShare app

Stunning, full-screen experience for iPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Managed Long Term Services


Published on

Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Pam Coleman

Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Pam Coleman

Published in: Business, Health & Medicine

  • Be the first to comment

  • Be the first to like this

No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

No notes for slide


  • 1. Albert llav/ kins, Execctive C. cnmr'issi3rer Managed Long Term Services Texas Health and Human Services Commission Pam Coleman October 14, 2007
  • 2. What is STAR+PLUS? I Risk-based, capitated managed care I Began in Harris County (Houston) in 1998 I Integrates Medicaid funding and service delivery of long term and acute care I Serves the aged and disabled not in nursing facility
  • 3. STAR+PLUS Expansion I ST AR+PLUS expanded to 4 new areas in February 2007 I Bexar, Travis, Nueces and Harris Contiguous Counties I Over 152,000 currently enrolled
  • 4. Measures of Success The following slides outline some of the indicators that are used to measure the progress of STAR+ PLUS.
  • 5. Access to Services: Results Increased use of preventative and support services (32°/ o increase in attendant care, 38°/ o increase in adult day care) Decreased use of acute medical services (28% decrease in hospital admissions) Decrease in Emergency Room Visits Members rate their HMOs high on providing needed services, equipment, and assistance (8.2 on 10 point scale) Source — Irl§titute for Child Health Policy, 2003
  • 6. Personal Assistance Services STAR+PLUS Unique Members Receiving Personal Attendant Services 200009 200109 200209 200309
  • 7. Quality: Results External review completed July 2003 Sickest STAR+PLUS members were compared to equally sick people in a non-capitated primary care case management program Significant cost difference ($3,226 mo in STAR+PLUS vs. $13,160 mo in comparison group) Significant reduction in inpatient and ER use, especially in HMO with larger number of care coordinators Source: Institute for Child Health Policy, November 2003 ix
  • 8. ll’ ‘ _I_ l‘ [‘lIlj“ . '.. ~“. ; li'-l“ ,1 I; 1‘ 4?‘ k‘2r. '‘— . Jay ‘W. , “ 2. I . + ‘M Vim. ‘ . 1'»m'1~ IV ’, ‘: vi. _. Overall Expenditures 40000 35000 30000 25000 -353 Ulé $6 6% $3 10000 5000 Average Charges per Month Al Hczllhy S’g-rficanl Aculc Minor Chronic Dom in: mUM our: 1.1!: “alignancics 8 Chron c Chalaslropmc IT STAR+PLUS Experiment Group ' l STAR Control Group
  • 9. Challenges for Implementation Consumers Perspective I Perception of evil gatekeeper HMOs I Concern with HMO’s lack of experience with LTSS I Concern that the medical model with be emphasized over support and community service needs I Concern that high need consumers will be directed to NFs I Concern that gains in CDS will be lost
  • 10. Challenges for Implementation LTSS Providers I Many unsophisticated providers I Requires significant education for both providers and the health plan I Health plan claims payment systems will need to be adapted I Health plan must have provider outreach capacity 10
  • 11. Challenges for Implementation Automation issues I State eligibility systems must be able to accurately identify HMO LTSS members I Encounter system will need to recognize LTSS encounters I HMOs must have systems that can track HCBS members I HMO systems must be able to handle retroactive Medicare coverage
  • 12. Lessons Learned HMO Staffing I Staffing ratios exceed typical HMO levels by at least three-fold I Training should focus on chronic care versus acute model I Multi-disciplinary teams: SW, RN, BH I Significant f/ ‘e/ d-based activity and staff
  • 13. Lessons Learned Care Coordination I Health plans with more care coordinators have better performance I Care coordinators must be empowered to authorize LTSS I Care coordinators must be responsive accessible to members I Involvement of all caregivers in CC plan development I 24/7 on—line access to current care plan 13
  • 14. Lessons Learned Dual Eligibles I Must focus on inpatient even if not responsible for acute care — SNPs help address this issue I Anticipate needs in member's home during inpatients stays to facilitate subsequent discharge 14
  • 15. Lessons Learned Pharmacy I High intensity use and significant potential for drug—drug issues I Care management focus on client Rx compliance I Drug utilization review must be part of care coordination plan 15
  • 16. Lessons Learned Comprehensive Benefits I Pre—auth rules must be moderated I Transportation must be easy to access I Generous use of benefit substitution principle will encourage creativity in delivery system 16
  • 17. Lessons Learned Value Added Benefits I Potential incentives to select a plan I Must be scrutinized by the state to avoid risk selection impacts I May provide real value to members I Enables the marketplace to ‘work’ by educating consumers 17
  • 18. Final Thoughts I Integrated programs are challenging but offer many benefits to consumers and states I HMOs must treat this as a dedicated line of business, not an add-on to other I States must hire dedicated staff to manage these programs Massive, coordinated education required I Include consumers in design and implementation
  • 19. Medicaid & CHIP ~- “"i"‘, ""°'”"’, °,"‘__, Managed care Service Areas with N003 Msions (in rod) Tammi CSA I7: = - l Vic u ‘llll i’liIi' Daflas csg mr, v.. .., ».<i u: l ll| .. ,, , ,,, .,I, ,, . .~l . ‘i "r ‘l 4 . ._i. .i, ~.~iw . ' "" ' """"' “‘ " " l‘iillii-Ji'~Tll| i: ~ Lubbock SDA : ~l(| ’ll1: “Milli; || IIi | i| ~I»‘: H I ll'l‘i ‘, v.ii--rlltililil". .i. . ‘l‘IIl| 'l Travis CSA i, ii_: u A] -, y ‘ min i‘; _ '. sl i-. l'll. X "S siipmn i~. i i~ l‘: mu. .i ll| l'. inl; ~ II llilx -1.! ‘ JiIlI'_i””: ,lI'~-r : il)1.| “ ‘-Ii‘-Jltl ll: ilili i'| .niil M-‘. , I‘ iiii‘i Har'isVCH| F O-SA '. ni l I’l"yl‘| . iiuur 1-” c, v,_°_sA ‘ I ll . ll-4:. “ ‘” ‘ Hams CSA 'i; _mis ]}l_ . -;-. ui‘{"y e""'cSA lll(lll‘iiu'v -’i. RI EIIF ~. -. 'v'><ll"« -' lg ‘-‘ " 4 . .i. ii, -. Ll.4i. :i‘IliHlll: l' ‘i ‘ “‘ l "‘ l. :ii'u: i ‘ ‘ I i. m.m l, iii: >l‘. R(ll| l‘i ‘l l‘ l ll . i, ‘-»i'~‘ | -—< '57‘-K1|l1Y'l 1.-. ... l. > l. .lL'llI xi li I ‘ll l D11-Mr-M A. vskii-irsl-uii‘iiIl' NuecescsA I | ll| .|lll'iil| I ' . » igp ‘V D i; v~i= u. —‘ . i.lm. u . .-. v. .i' 5". I . — Wtrbb CSA . ‘ 3, , , H 3;: ,, . . ,,, ,, , -H". I'ilIi-um ml xl Mt iimgi I‘| | xi " T "T V ‘y H L». .- . i llil‘ l I i . -ii II. ‘-(I. .v. l_ , i.; .,l>, li-. m. i. . v I V H I-( | l]"'! ‘.“| lll4I . |li ‘I. -H ifl. i I l'. 'll H ' inrr ll . i-vr. i'ii. . l‘: .