YOUR LIFE... YOUR HEALTH... YOUR CHOICE Copyright © 2003 AXIS Healthcare, LLC. All Rights Reserved. The AXIS Experiment: Can People

YOUR LIFE . . . YOUR HEALTH . . . YOUR CHOICEYOUR LIFE . . . YOUR HEALTH . . . YOUR CHOICEwww.AxisHealth.com

Copyright © 2003 AXIS Healthcare, LLC. All Rights Reserved.

The AXIS Experiment: Can People with The AXIS Experiment: Can People with Disabilities be Better Served in Managed Disabilities be Better Served in Managed

Care or Fee-For-ServiceCare or Fee-For-Service

ILRU WebCastILRU WebCastSeptember 10, 2003September 10, 2003

Chris Duff, AXIS CEOChris Duff, AXIS CEORon Franke, AXIS MemberRon Franke, AXIS Member

John Tschida, AXIS Board MemberJohn Tschida, AXIS Board Member

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YOUR HEALTH . . . YOUR LIFE . . . YOUR CHOICEYOUR HEALTH . . . YOUR LIFE . . . YOUR CHOICE AXIS HealthcareAXIS Healthcare

OurOur Vision Vision AXIS envisions a time when all people, regardless of ability, AXIS envisions a time when all people, regardless of ability, will have the health care services and supports needed for will have the health care services and supports needed for lives they find meaningful and productive. lives they find meaningful and productive.

OurOur Strategy Strategy

To work in partnership with persons with physical disabilities, as To work in partnership with persons with physical disabilities, as well as their key providers and payors, to address their needs by well as their key providers and payors, to address their needs by coordinating a high-quality, cost effective network of specialized coordinating a high-quality, cost effective network of specialized services, spanning the continuum of care and support. services, spanning the continuum of care and support.

A joint venture ofA joint venture of

Courage CenterCourage Center and and Sister Kenny InstituteSister Kenny Institute,,

About AXIS HealthcareAbout AXIS Healthcare

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What’s wrong with the FFS ModelWhat’s wrong with the FFS Model

Islands of care… resulting in one-dimensional servicesIslands of care… resulting in one-dimensional services

Created and managed to serve the masses… resulting in Created and managed to serve the masses… resulting in limited service delivery flexibility and systems to control limited service delivery flexibility and systems to control utilizationutilization

Care is diagnosis or treatment based… resulting in avoidable Care is diagnosis or treatment based… resulting in avoidable acute episodes and/or progression of chronic conditionsacute episodes and/or progression of chronic conditions

Decisions and responsibility lie with the purchasers or Decisions and responsibility lie with the purchasers or providers… resulting in disempowerment of the individual providers… resulting in disempowerment of the individual needing servicesneeding services

Costs are escalating significantly faster then medical inflationCosts are escalating significantly faster then medical inflation

The more one needs health care… The more one needs health care… the more one hates the health care the more one hates the health care

systemsystem

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ConsumerConsumer&&

Support PersonsSupport Persons

Primary Care

Primary Care

Hospitals

Hospitals

Residential Residential

ServicesServices

Medical Medical

Specialists

Specialists

Mental Mental Health

Health

The Current Healthcare System…The Current Healthcare System…

Rehabilitation

Rehabilitation

??

Home Care / PCA

Home Care / PCA

DME / SuppliesDME / Supplies

……there must be a better waythere must be a better way

The Current Health Care Delivery SystemThe Current Health Care Delivery System

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Challenges of Creating New ModelsChallenges of Creating New Models

• Engaging and incenting all stakeholders – consumers, Engaging and incenting all stakeholders – consumers, providers, payors and purchasersproviders, payors and purchasers

• Creating adequate rate setting and risk adjustment Creating adequate rate setting and risk adjustment methodologiesmethodologies

• Establishing consumer confidence in the modelEstablishing consumer confidence in the model

• Transitioning the locus of health information from the Transitioning the locus of health information from the provider to the consumer… thereby preparing the provider to the consumer… thereby preparing the consumer to assume greater responsibility and controlconsumer to assume greater responsibility and control

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Developing the AXIS ModelDeveloping the AXIS Model

ConsumersConsumers

Purchasers/

Purchasers/

Payors

Payors

Providers

Providers

•Identified NeedsIdentified Needs•Pilot ProjectPilot Project•OutreachOutreach•Consumer WorkgroupConsumer Workgroup

• Built Capitation ModelBuilt Capitation Model• Obtained WaiversObtained Waivers• Built NetworkBuilt Network• Contracted Disability Contracted Disability

Care SystemCare System

• Created new care modelsCreated new care models• Participated in pilot Participated in pilot

projectproject• Engaged consumersEngaged consumers

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MnDHO EligibilityMnDHO Eligibility

Persons ServedPersons Served Medicaid and Medicare recipients, aged 18 – 64 Medicaid and Medicare recipients, aged 18 – 64 Voluntary enrollment, projected to grow to 200-400Voluntary enrollment, projected to grow to 200-400 Individuals with primary diagnosis of a physical disability, who would Individuals with primary diagnosis of a physical disability, who would

benefit from the health coordination modelbenefit from the health coordination model

Geographic ScopeGeographic Scope Twin Cities Metropolitan AreaTwin Cities Metropolitan Area

Covered ServicesCovered Services Includes all Medicare and Medicaid services, including Home & Includes all Medicare and Medicaid services, including Home &

Community-based Services Community-based Services

Capitation:Capitation: Medicare AAPCC, with PACE Adjuster for persons at risk of Medicare AAPCC, with PACE Adjuster for persons at risk of

institutionalizationinstitutionalization Medicaid rates ranging from $400 to $19,000, based on acuityMedicaid rates ranging from $400 to $19,000, based on acuity Planning to transition to C-DPS for acute care component of Medicaid Planning to transition to C-DPS for acute care component of Medicaid

capitation capitation

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Project PartnersProject Partners

• State Medicaid OfficeState Medicaid Office• Manages MnDHO WaiversManages MnDHO Waivers• Contracts with Health Plans for Managed Care ProjectsContracts with Health Plans for Managed Care Projects

• Medicaid and Medicare + Choice PlanMedicaid and Medicare + Choice Plan• 90,000+ members90,000+ members• Sole MnDHO PlanSole MnDHO Plan• Contracts with disability CMO, providersContracts with disability CMO, providers

• Provider-sponsored CMOProvider-sponsored CMO• Created to demonstrate new model of Managed CareCreated to demonstrate new model of Managed Care• Primary link to disability communityPrimary link to disability community• Experiences with H&CB services and key providersExperiences with H&CB services and key providers

---

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AXIS’ RoleAXIS’ Role

1.1. EnrollmentEnrollment• Outreach to prospective membersOutreach to prospective members• Pre-assessment enrollment visit to explain programPre-assessment enrollment visit to explain program

2.2. Member ServicesMember Services• First point of contact for membersFirst point of contact for members• Communications and arrangements with providersCommunications and arrangements with providers

3.3. Provider RelationsProvider Relations• Identification and engagement of needed providersIdentification and engagement of needed providers• Referral managementReferral management• Fee negotiation for services outside fee scheduleFee negotiation for services outside fee schedule

4.4. Utilization ManagementUtilization Management• Ensure timely, coordinated services covering full continuum of careEnsure timely, coordinated services covering full continuum of care• Urgent assessment and intervention by RN 24/7Urgent assessment and intervention by RN 24/7• Authorization authority covering all servicesAuthorization authority covering all services

Slide 10


AXIS’ RoleAXIS’ Role

Health CoordinationHealth Coordination

– Partner with member and PCP to ensure effective and Partner with member and PCP to ensure effective and coordinated carecoordinated care

– Coordinate entire spectrum of health care from acute care to Coordinate entire spectrum of health care from acute care to mental health and community-based servicesmental health and community-based services

– 24/7 availability for emergent concerns24/7 availability for emergent concerns

– Refer for appropriate services and care from experienced Refer for appropriate services and care from experienced providersproviders

– Utilize prevention and risk management strategiesUtilize prevention and risk management strategies

– Involve consumers to facilitate self-responsibility for health Involve consumers to facilitate self-responsibility for health statusstatus

– Coordinate related services; including vocational, Coordinate related services; including vocational, educational, housing, social services, recreationaleducational, housing, social services, recreational

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Objective of the Network:Objective of the Network: To have a comprehensive network of committed providers To have a comprehensive network of committed providers experienced in serving persons with physical disabilities, experienced in serving persons with physical disabilities, spanning the continuum from acute and primary care, home and spanning the continuum from acute and primary care, home and community-based care and mental health servicescommunity-based care and mental health services

Development of the Provider NetworkDevelopment of the Provider Network

Identification Process:Identification Process:• Interviews with staff from rehabilitation organizationInterviews with staff from rehabilitation organization• Identification of referral preferences of primary care physiciansIdentification of referral preferences of primary care physicians• Consumer experiences and preferences obtained through focus Consumer experiences and preferences obtained through focus

groups, individual interviews and Consumer Workgroupgroups, individual interviews and Consumer Workgroup• Tracking provider utilization by participants in the pilot health Tracking provider utilization by participants in the pilot health

coordination projectscoordination projects• Review of existing county-based waiver provider contractsReview of existing county-based waiver provider contracts• Providers who have expressed interest in the AXIS model, and Providers who have expressed interest in the AXIS model, and

have come forward with creative service delivery ideashave come forward with creative service delivery ideas

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What AXIS Does: A Member PerspectiveWhat AXIS Does: A Member Perspective

Previous Experience of Medicaid SystemPrevious Experience of Medicaid System– Could never get the answers I neededCould never get the answers I needed– Referred from one place to the next, many of which were Referred from one place to the next, many of which were

fruitlessfruitless– Competency varied greatly among providersCompetency varied greatly among providers– Help was available, but on their timelineHelp was available, but on their timeline– Things happened to me, instead of me being able to make Things happened to me, instead of me being able to make

things happenthings happen

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55 weeks in a nursing home55 weeks in a nursing home– Skin breakdown wasn’t identified until to became a significant Skin breakdown wasn’t identified until to became a significant

problemproblem– Homecare treatment was slow and ineffectiveHomecare treatment was slow and ineffective– Progressed to surgery and nine months on bed restProgressed to surgery and nine months on bed rest– Never lost hope of returning home, but didn’t know how I Never lost hope of returning home, but didn’t know how I

could make it happencould make it happen

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AXIS helped me build a plan to get homeAXIS helped me build a plan to get home– Enrolled while in nursing homeEnrolled while in nursing home– Health Coordinator and I pulled my family and friends together Health Coordinator and I pulled my family and friends together

to work out all the logisticsto work out all the logistics– AXIS authorized all the services I needed on a daily basis AXIS authorized all the services I needed on a daily basis – I moved home 30 days laterI moved home 30 days later

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What’s different with AXISWhat’s different with AXIS– I am no longer aloneI am no longer alone– When I have a problem or concern, I get useful help When I have a problem or concern, I get useful help

immediatelyimmediately– When I started to have some skin breakdown, my health When I started to have some skin breakdown, my health

coordinator was out here immediately, and a skin care nurse coordinator was out here immediately, and a skin care nurse was in my home the next day… it was treated and resolved in was in my home the next day… it was treated and resolved in a few weeks of partial bed resta few weeks of partial bed rest

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Why AXIS works for meWhy AXIS works for me– I know I can always get the help I need… I no longer have to I know I can always get the help I need… I no longer have to

worry about living aloneworry about living alone– My health coordinator suggests thing I wouldn’t have thought My health coordinator suggests thing I wouldn’t have thought

about… I get new toys to help me as my MS progressesabout… I get new toys to help me as my MS progresses– My quality of life is far better… and I’m a lot cheaper for the My quality of life is far better… and I’m a lot cheaper for the

governmentgovernment

Slide 17


Developing the AXIS ModelDeveloping the AXIS Model

ConsumersConsumers

Purchasers/

Purchasers/

Payors

Payors

Providers

Providers

•Identified NeedsIdentified Needs•Pilot ProjectPilot Project•OutreachOutreach•Consumer WorkgroupConsumer Workgroup

• Built Capitation ModelBuilt Capitation Model• Obtained WaiversObtained Waivers• Built NetworkBuilt Network• Contracted Disability Contracted Disability

Care SystemCare System

• Created new care modelsCreated new care models• Participated in pilot Participated in pilot

projectproject• Engaged consumersEngaged consumers

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Why this Model WorksWhy this Model Works

Payor: State Medicaid PerspectivePayor: State Medicaid Perspective– Helps control costs for its ‘outlier’ population of individuals Helps control costs for its ‘outlier’ population of individuals

with disabilitieswith disabilities• People with disabilities exempt from managed care in MinnesotaPeople with disabilities exempt from managed care in Minnesota

• Capitation provides incentive to manage health and dollarsCapitation provides incentive to manage health and dollars

• Sensitive risk adjustment system better matches cost and careSensitive risk adjustment system better matches cost and care

– State transfers risk to other entitiesState transfers risk to other entities• AXIS and Ucare have negotiated risk corridor for profit/lossAXIS and Ucare have negotiated risk corridor for profit/loss

• Stop-loss protection guards against high cost casesStop-loss protection guards against high cost cases

• No opt-out conditions for high-cost diagnosesNo opt-out conditions for high-cost diagnoses

• Pharmacy carve-out is only exceptionPharmacy carve-out is only exception

– The potential for expansionThe potential for expansion• Boutique size allows for successful midstream correctionsBoutique size allows for successful midstream corrections

• Can learnings transfer to other locations and populations?Can learnings transfer to other locations and populations?

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Providers: Providers: – UCareUCare

• Mission fit: an opportunity to improve care for a defined Mission fit: an opportunity to improve care for a defined population within public health programspopulation within public health programs

• Symbiotic core competencies: AXIS brings benefit that Ucare Symbiotic core competencies: AXIS brings benefit that Ucare doesn’t havedoesn’t have

• The numbers work: fiscal analysis makes senseThe numbers work: fiscal analysis makes sense

• Size matters: slow, steady implementation is manageableSize matters: slow, steady implementation is manageable

– Direct Care ProvidersDirect Care Providers• Primary clinics have steady stream of referralsPrimary clinics have steady stream of referrals

• Additional team support from AXIS in negotiating barriers on Additional team support from AXIS in negotiating barriers on behalf of consumersbehalf of consumers

• AXIS serves as medical ‘home’ with a holistic view of each AXIS serves as medical ‘home’ with a holistic view of each consumer and their care planconsumer and their care plan

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• Consumers:Consumers:– Voluntary in natureVoluntary in nature

• Enrollees can return to FFS without minimum ‘lock-in’ period or Enrollees can return to FFS without minimum ‘lock-in’ period or consequencesconsequences

• Quality of care drives AXIS behaviorQuality of care drives AXIS behavior

– FlexibilityFlexibility• Capitation allows for creativity not found in FFS health care Capitation allows for creativity not found in FFS health care

purchasingpurchasing• Consumers identify goals and priorities, the dollars flow to Consumers identify goals and priorities, the dollars flow to

support themsupport them

– More than just a health planMore than just a health plan• AXIS uses better health to support quality of life, community AXIS uses better health to support quality of life, community

integrationintegration• Work, home, and community engagement needs evaluated and Work, home, and community engagement needs evaluated and

supported by unique consumer health planssupported by unique consumer health plans

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• Consumers:Consumers:– Tangible resultsTangible results

• Hospitalizations have been more than halved, to 100 Hospitalizations have been more than halved, to 100 hospitalizations/1,000 membershospitalizations/1,000 members

• Hospital length of stay has been reduced by more than 60%. Hospital length of stay has been reduced by more than 60%.

• 40+ people have been transitioned out of nursing homes40+ people have been transitioned out of nursing homes

• 90% of members report satisfaction with their health care 90% of members report satisfaction with their health care services, as compared with 10% satisfaction prior to enrollment.services, as compared with 10% satisfaction prior to enrollment.

• 85% of members reported receiving help managing their health 85% of members reported receiving help managing their health care services, as compared with 5% receiving help prior to care services, as compared with 5% receiving help prior to enrollment.enrollment.

Slide 22


What’s next?What’s next?

• Policy implications:Policy implications:– Can AXIS model expand to other places and populations?Can AXIS model expand to other places and populations?

• Current FFS expenditures and demographics indicate continued Current FFS expenditures and demographics indicate continued cost growthcost growth

• Individuals with mental illness and developmental disabilities Individuals with mental illness and developmental disabilities experience similar challenges with health care and community experience similar challenges with health care and community livingliving

– What can AXIS offer the private insurance market?What can AXIS offer the private insurance market?

• Trend of consumer-driven health care is increasingTrend of consumer-driven health care is increasing

• Traditional disease management programs don’t address needs Traditional disease management programs don’t address needs of people with disabilitiesof people with disabilities

• Commercial market potential Commercial market potential

• Employer-based purchasing to better manage medically complex Employer-based purchasing to better manage medically complex individualsindividuals

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New Week: EvaluationNew Week: Evaluation

DevelopDevelop a range of evaluation components to:a range of evaluation components to:• Ensure the delivery of health care services consistent with Ensure the delivery of health care services consistent with

current best practicescurrent best practices

• Measure program for effectiveness, and reengineer the way Measure program for effectiveness, and reengineer the way services are provided in the futureservices are provided in the future

• Identify key elements that lead to desired outcomes, then Identify key elements that lead to desired outcomes, then standardize the elements into practice protocolsstandardize the elements into practice protocols

• Demonstrate the benefits of the AXIS/UCare project to Demonstrate the benefits of the AXIS/UCare project to stakeholdersstakeholders

• Demonstrate improved outcomes by managing care for Demonstrate improved outcomes by managing care for members and setting the standard for future managed care members and setting the standard for future managed care programsprograms

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YOUR LIFE... YOUR HEALTH... YOUR CHOICE Copyright © 2003 AXIS Healthcare, LLC. All Rights Reserved. The AXIS Experiment: Can People