The financing model will be capitation Dually eligible persons include: Frail elderly Mentally ill Developmentally disabled
There will be a three way contracting process developed. Contracts will specify expectations and include incentives to assure the relationships are built for maximum coordination and integration. State will configure ICO and PIHP boundaries so they will be aligned. Regions are unlikely to conform to current Medicaid HMO and PIHP regions. MDCH states that a major consideration of the two contract approach is to avoid destabalizing the current system and to recognize the value of the existing delivery system.
In addition, PIHPS and ICOs will be required to share a secure electronic platform that contains at a minimum- A current integrated problems list as required in medical records A single integrated person-centered plan of care A current medication list Care management notes that contain real-time information on most recent contacts, including emergency services. By the end of the demonstration, PIHPs and ICOs must share an integrated electronic record that also includes lab and diagnostic results, progress notes for all disciplines, physician orders, consultations and care planning and supports coordination team notes.
The quarterly phase-in will be done by region and within each region by population. Beneficiaries may have the choice between two or more ICOs; however, only one PIHP will be available. The state will configure the ICO and PIHP boundaries so they will be alligned. Therefore, geographic regions are unlikely to conform to current Medicaid HMO or PIHP regions. There will likely be 5 -8 regions developed.
MPCA will have staff at both events and will likely also be submitting email comments. Today at Health Policy we will discuss the proposed plan.
We still have questions about who will manage the care for the mild to moderate mental health needs The terms primary care medical home, patient centered medical home and health homes are used and we need to determine what was meant by each. We also need to determine if MDCH intended to say they would be applying for Health Homes, which is only referenced in relation to the PIHPs. We will need to determine how FQHC payment will get to centers We don’t know of the care coordination in the care bridge will be at the ICO/PIHP level or “one the ground” in the clinic setting.
Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible
MICHIGAN’S INTEGRATEDCARE PLAN FOR PEOPLE WHOARE MEDICARE-MEDICAIDELIGIBLE A Discussion with MPCA Membership March 19, 2012
Purpose of Today’s Webinar Develop a common understanding of the components of Michigan’s plan Develop a list of questions health centers would like to have clarified Discuss potential implications for health centers and the patients we serve and MPCA’s response
Michigan’s Integration Goals• Seamless delivery of services• Reduce fragmentation• Reduce barriers to home and community- based services• Improve quality of services• Simplify administration for beneficiaries & providers• Cost effectiveness aligning financial incentives
The Plan Development Process• Planning Contract received (April, 2011)• Multiple stakeholder input activities (July – December) • Interviews, forums, request for input, workgroups, written comments• Proposed Plan Issued (March 5, 2012)• Public Input on Plan (30 days)• MDCH forums (March 20th, March 29th)• Submission to CMS – April 26, 2012• Implementation begins July 2013
The Proposal Change financing model for ~ 200,000 persons who are dually covered by Medicare and Medicaid. ◦ Move from the current Fee For Service model to an organized system of care.
Plan StructureIntegrated Care Prepaid Inpatient HealthOrganizations (ICOs) Plans (PIHPs)• ICOs will contract with: • PIHPs will contract with: • Physical Health • CMHSPs Providers • Behavioral Health • Long Term Care Providers Providers
Integrated Care Organizations(ICOs)The ICO is responsible for financing and coordinatingbenefits:Medicare Part A & B (primary & acute care).Pharmacy Part DLong term care services & supports including communitybased and nursing facility, both skilled and custodialManagement of person-centered medical homeCare and supports coordination team
Prepaid Inpatient Health Plans (PIHPs)The PIHP is responsible for financing andcoordinating benefits for all behavioral healthservices for persons with: Intellectual/developmental disabilities Serious mental illness substance use disorders Care and supports coordination team
How Integration Happens –The Care Bridge• A services or supports coordinator leads a multidisciplinary team to coordinate services & supports for the beneficiary according to a self determined, person centered plan of care.• The services or supports coordinator has 24/7 contact responsibility for the beneficiary• Leading coordinating entity (ICO or PIHP) is defined by beneficiary and highest care need. 10
Enrollment process Passive enrollment - beneficiary enrolled unless they indicate a choice to opt out Open enrollment for two months during phased implementation and subsequent enrollment Post enrollment there will be a single person-centered screening and assessment tool and process 11
Quarterly Phase In-Geographic• Beginning July, 2013 – all beneficiaries in plan by June, 2014• People enrolled at quarterly Intervals using several regional areas• Regions developed based on potential for enrollment volume and other readiness factors• First group of counties will be selected to assure sufficient # of enrollees to demonstrate the plan, but will include less than ½ the population• Remaining counties grouped along logical geographic and health care market lines
Quarterly Phase In-Populations1st Quarter – Persons with: • Physical disabilities • Serious mental illnesses • Substance use disorders • Older adults not in nursing facilities2nd Quarter– Persons using long term care services in: • Nursing facilities • MI Choice Waiver 3rd Phase– Persons with intellectual/developmental disabilities 13
Public Input OpportunitiesCopy of Plan at: www.michigan.gov/mdchMDCH Forums • March 20th, 1:30 – 4:00 p.m.; Best Western Hotel (Causeway Bay), Lansing • March 29th, 1:30 – 4:00 p.m.; Greater Grace Temple, DetroitComments by email at: IntegratedCare@michigan.govDue no later than close of business April 4, 2012 14
Impact on Michigan CHCs Michigan CHCs are currently serving approximately 22,600 Dual Eligible Individuals. The number of duals in CHCs should continue to grow with Medicaid expansion and the aging of the baby boomers. Health Centers currently contract with many of the likely ICOs. We will need to be sure the Medicaid provisions that require contracts with FQHCs are included. Maintenance of Medicaid PPS will be critical and Michigan Medicaid’s share of PPS will be greater for duals.