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Section 1115 Medicaid Waiver RenewalSafety Net Financing
Expert Stakeholder Workgroup #2Mari Cantwell
Department of Health Care ServicesJanuary 12, 2015
1
Workgroup Agenda
2
Status Update
3
Recap of Meeting #1
4
Recap of Meeting #1 (continued)
5
Bridge to Reform Waiver DSH/SNCP Allocations
Bridge to Reform Waiver DSH/SNCP Allocations
6
BTR DSH/SNCP Allocations (DY 10 – FY2014/15 Estimates)
• Current DSH/SNCP allocation methodologies for DPHs:– DSH allocation formula (Estimated Federal Funds: $1,176M)
• Specific allocation amount ($12M)
• Per discharge amounts ($179.7M) :– Medi-Cal: $750 per discharge ($122.6M; 163,465 discharges))
– LIHP: $900 per discharge ($15.8M; 17,506 discharges)
– Uninsured : $1,100 per discharge ($41.3M; 37,577 discharges)
• Remainder allocated using pro-rata distribution based on DSH eligible costs - uncompensated Medi-Cal and Uninsured costs ($984.6M)
– SNCP allocation formula (Estimated Federal Funds: $236M) :• Pro-rata allocation according to SNCP eligible uninsured costs
7
Global Budget /Coordinated Care for the
Uninsured
Global Budget /Coordinated Care for the Uninsured
8
Key Goals/Concepts
9
Methodology
10
Methodology (continued)
11
Service Categories
12
Category 1: Face-to-Face Outpatient Visits
13
Category 2: Technology-Based Outpatient Encounters
14
Category 3: Non-Office Based Outpatient Encounters
15
Category 4: Preventive Health, Education, Care
Management, and Patient Support Encounters
16
Category 5: Inpatient/Facility Stays
17
Service Categories/Point Valuation
18
Hypothetical Example
Hypothetical Example
19
Hypothetical Example
20
Hypothetical Example (continued)First, establish the “threshold point value” for the system by assigning relative values based on how the current system works and traditional/non-traditional services are or are not reimbursable
Category Service Units Points per Unit Total Points1 Outpatient primary care visit 1,000 10 10,000 1 ER visit 3,000 25 75,000 2 Telephone consultation 500 - - 3 Paramedic treat & release 700 - - 3 Community health worker encounter 500 - - 4 Support group 100 - - 5 Inpatient day 2,500 40 100,000
185,000
Current System/Services (Hypothetical Points)
Threshold Point Value
21
Hypothetical Example (continued).Next, after valuing services to recognize high-value of coordinated care and value of non-traditional services, measure total points based on actual services provided in the given year.
Category Service Units Points per Unit Total Points1 Outpatient primary care visit 1,750 20 35,000 1 ER visit 1,750 20 35,000 2 Telephone consultation 1,000 15 15,000 2 Telemedicine 1,000 15 15,000 2 eConsult 300 10 3,000 3 Paramedic treat & release 700 10 7,000 3 Community health worker encounter 750 10 7,500 4 Support group 150 5 750 5 Inpatient day 2,000 35 70,000
188,250
3,250
Future System/Services with Services Valued to Reflect Goals
Total PointsAmount above/
(below) threshold
22
Evaluation and Accountability
Evaluation and Accountability
23
Evaluation/Accountability
24
Evaluation/Accountability (continued)
Resource Allocation – measures of the shift in the balance of carePotential metrics
– Ratio of primary to specialty care visits– Ratio of new to follow-up appointments within specialty care– Average time to discharge from specialty care– Ratio of primary care to emergency room/urgent care visits– Mental health/substance use disorder visits– Inpatient stays related to ambulatory sensitive conditions
Workforce involvement – investment in alternative uses of workforce to expand access and provide higher quality care for lower long term costsPotential metrics
– Use of non-traditional workforce classifications (e.g. CHWs)– Expansion of roles/responsibilities (within scope of practice) for traditional
workforce classifications
25
Questions and Discussion
Questions and Discussion
26
Key Questions
27
Next Steps
Next Steps
28