This week, our In Focus section provides a recap of the fourth annual HMA Conference, The Next Wave of Medicaid Growth and Opportunity: How Payers, Providers, and States are Positioning Themselves for Success, held this Monday, September 9, and Tuesday, September 10, in Chicago, Illinois. Nearly 500 leading executives representing managed care organizations, providers, state and federal government, community-based organizations, and other stakeholders in the health care field gathered to address the challenges and opportunities for organizations serving Medicaid and other vulnerable populations. Conference participants heard from keynote speakers, engaged in panel discussions, and connected during informal networking opportunities. Below is a summary of highlights from this year’s conference.
“Medicaid Inner Workings: Program Basics, Key Variations and Behavioral Health”
Prior to the conference, HMA provided an overview of the Medicaid program, including a look at benefits and eligibility, the role of managed care, and key differences between the Medicaid and Medicare programs. Speakers discussed how states are addressing special populations through waivers, state plan amendments, and delivery system reform incentive payment (DSRIP) programs. Speakers provided examples of what is being done to address behavioral health and addiction issues by providers, managed care organizations, and states. The session concluded with a discussion on the vital role of social determinants of health, the continued use of RFPs from states to transform healthcare, and the increasing importance of technology solutions in caring for Medicaid recipients. HMA speakers included Betsy Jones, Managing Principal; Corey Waller, MD, Principal; Donna Checkett, Vice President of Business Development; Izanne Leonard-Haak, Managing Principal; Jean Glossa, MD, Managing Principal; Josh Rubin, Principal; Matt Powers, Managing Director MMS; and Sarah Barth, Principal.
“Medicaid and the Future of Healthcare: Does Medicaid Represent the Future of Healthcare in America?”
Alan Weil, Editor-in-Chief of Health Affairs, highlighted the strengths and weaknesses of Medicaid, noting that the program is unique in its ability to control costs, has held the line on counter-productive member cost sharing, has singlehandedly driven delivery system redesign, and has built out “waiver by waiver” a comprehensive collection of clinical and social services necessary to support member health. He specifically noted that the private sector is incapable of implementing meaningful cost containment initiatives, whereas Medicaid has proven its capacity to innovate and spend less. “If you want to spend less, pay less,” he said. Weil also voiced his disapproval of Medicaid work requirements and said that value-based payments are “not ready for prime time.” Weil stated that the evidence of success is weak and value-based payment can force hospitals to selectively choose patients based on risk.
State Medicaid Director Q&A Session
“Opportunities and Pitfalls of Medicaid Innovation at the State Level”
State Medicaid directors discussed efforts to drive their Medicaid programs forward to meet the needs of beneficiaries. They underscored party politics and gridlock in state legislatures as chief barriers to keeping up the momentum of Medicaid programs. Speakers also addressed the growing role of Medicaid managed care. Mandy Cohen, MD, Secretary, North Carolina Department of Health and Human Services, detailed the state’s efforts to transition to a Medicaid managed care model. Other topics included the need for more data to evaluate how Medicaid is addressing social determinants of health, and political and financial levers state administrators have at their disposal to drive innovation. Other speakers included Stephanie Bates, Deputy Commissioner, Kentucky Department for Medicaid Services; Jami Snyder, Director, Arizona Health Care Cost Containment System; and Doug Elwell, Medicaid Director, Illinois Department of Healthcare and Family Services.
Medicaid Managed Care Keynote
“The Growing Role of Medicaid Managed Care in Serving the Nation’s Most Vulnerable”
Paul Tufano, Chairman, CEO, AmeriHealth Caritas, addressed the growing role managed care organizations play in not only managing care for the nation’s most vulnerable citizens, but also in recognizing and improving the social and environmental determinants of health. There is a need, he said to integrate the physical, behavioral, pharmaceutical and environmental into a “next generation model of care” that seeks to approach healthcare more holistically. Tufano outlined AmeriHealth Caritas’ integrated healthcare innovations in Medicaid, including the establishment of local wellness centers, which provide information on nutrition, housing, transportation and employment opportunities. Tufano also discussed the need for government support to invest Medicaid dollars in ways that reinforce a holistic approach to healthcare.
Medicaid Managed Care Keynote Q&A
“Delivering on the Promise of Medicaid Managed Care”
Leading health plans executives discussed the lack of efficiency in the state processes for procuring Medicaid managed care plans. For example, speakers addressed the need for greater clarity in the scoring process, which could lead to significant savings associated with legal protests; more transparency and certainty in RFP release dates and changes in award and procurement timings; and the need for setting page limits in plan responses. Other topics included increasing demands to ensure quality while controlling costs, the incorporation of social determinants of health into care plans, and the differences between traditional Medicaid and expansion populations. Speakers included Patrick Sturdivant, President, Amerigroup Texas, Anthem, Inc.; Heidi Garwood, President, Medicaid, Health Care Services Corporation; Deb Bacon, Regional Vice President, West/Other Region, Aetna Medicaid; Joanne McFall, Market President, Keystone First Health Plan; and Dennis Mouras, CEO, UnitedHealthcare Community Plan of Michigan.
“Substance Abuse Treatment and the Opioid Crisis: A New Way Forward”
Leading addiction experts discussed existing political, economic and social barriers to successful opioid addiction treatment and new ways states, providers and health plans can address substance abuse. Corey Waller, MD, Principal, HMA, identified the stigma associated with opioid addiction treatment and the lack of investment in behavioral health services aimed at addressing addiction. Carole Johnson, Commissioner, New Jersey Department of Human Services, outlined state initiatives to address social determinants of health, behavioral health and addiction treatment. Johnson identified the opportunities and challenges of serving members where they are, calling for a move away from discretionary spending and towards more enduring programs. “We need to deliver a clear and consistent message to change the hearts and minds about addiction,” Johnson stated, adding that there is a need to “integrate addiction treatment for all addictions, not just opioids.”
“Breakthroughs in Addressing SDOH”
Speakers during this panel discussed how state Medicaid programs, health plans and providers are progressively working together to identify and define social needs and implement innovative strategies to address social determinants of health, including food security, housing, education and interpersonal violence. Panelists outlined the strategic developments as well as programmatic challenges in the delivery and financing of services aimed at addressing social determinants of health. Betsey Tilson, MD, State Health Director, Chief Medical Officer, North Carolina Department of Health and Human Services, outlined her state’s pilot program that utilized a 1115 waiver to provide evidence-based interventions to integrate and finance non-medical services into the delivery of healthcare. Kevin Moore, Vice President, Policy – Health & Human Services, UnitedHealthcare Community & State, demonstrated how his health plan used standardized social determinants of health screenings data to effectively identify patient risk and allocate social services towards members with the highest risk. Other topics included the importance of payer-provider partnerships in the delivery of social determinants of health services. “The ability to successfully address social barriers is dependent on a robust and healthy community-based organization infrastructure,” Moore stated. Other speakers included Brad Lucas, MD, Senior Medical Director, Buckeye Health Plan; and Sharon Raggio, President, CEO, Mind Springs Health.
“Medicaid Expansion and Other Efforts to Expand Healthcare Coverage”
Speakers discussed how the decision to expand or not expand Medicaid has affected their states and systems of care. Key themes that emerged were lessons learned from previous expansions, regional differences in Medicaid expansion, and how increased flexibility in federal requirements could potentially influence non-expansion states. An 1115 waiver allowed Cook County to expand prior to the official January 2014 federal law trigger, giving Illinois an opportunity to test the program and understand cost differentials that were not previously considered, such as hospital outpatient, behavioral health, and long-term care expenditures. In Georgia, a recent election triggered a new discussion on expansion. The state will now think through how a recent decision by CMS to reject Utah’s waiver for a partial expansion affects their path. Speakers also discussed the burden of uncompensated care on safety net hospitals where Medicaid expansion could greatly improve access to care and relieve frustration from providers and patients. Speakers included Fred Cerise, MD, President, CEO, Parkland Health & Hospital System; Theresa Eagleson, Director, Illinois Department of Healthcare and Family Services; Jimmy Lewis, CEO HomeTown Health, LLC; and Dennis Smith, Senior Advisor, Medicaid and Health Care Reform, Arkansas Department of Human Services.
“Innovations in Managing Drug Spending – Value-Based Purchasing”
Speakers discussed some of the most innovative concepts and initiatives in the intersection of value-based purchasing (VBP) and drug spending. In Oklahoma, Medicaid nearly 43 percent of total pharmacy expenditures went to less than 1 percent of claims for medications costing more than $1,000. Speakers looked at various VBP models to tackle this problem, including when a fee-for-service model delivers a better return on investment. Speakers included John Coster, Director of Division of Pharmacy Center for Medicaid and CHIP Services, CMS; Terry Cothran, Director of Pharmacy Management Consultants, University of Oklahoma College of Pharmacy; Josh Fredell, Senior Director of Specialty Product Development, CVS Health; and Darren Moore, Senior Director of Value and Market Access, Melinta Therapeutics.
Investor Breakout Session
“Innovative Delivery Models in Medicaid-Focused Healthcare Services”
During this breakout session, executives from private-equity backed companies discussed innovative delivery models within growing market segments such as applied behavior analysis (ABA) for individuals with autism, long-term services and supports, nutrition support services, high quality behavioral health care delivered in school settings, and health plan provider network development and monitoring. Panelists discussed the need to address fragmentation in their industries by creating strong community bonds and acquiring smaller firms that provide similar services. Several panelists noted the importance of investing in their employees through activities like advocating for better wages and supporting continued professional training and development. Another key theme was providing value through new technology and tools that monitor quality and patient improvements as well as assist health plans in pricing services or complying with regulations. Speakers included Keith Jones, President & CEO, Blue Sprig Pediatrics; Mark Lashley, CEO, Caregiver, Inc.; Cari Lee, VP, Government Affairs, Quest Analytics; Timothy Murphy, CEO, The Stepping Stones Group; and Nestor Plana, Chairman, CEO, Independent Living Systems. The panel was moderated by Whit Knier, Director, Harris Williams Healthcare & Life Sciences Group.
Breakout Session 2
“Successful Models and Variations in Behavioral Health Integration”
Leading medical and behavioral health experts addressed innovative approaches and significant hurdles to behavioral health integration, highlighting a variety of solutions implemented by both payers and providers to integrate behavioral and physical health care. A key theme surrounded the importance of shifting away from standalone behavioral health centers towards a more integrated primary care space. Elise Pomerance, MD, Senior Medical Director, Practice Transformation, Inland Empire Health Plan, discussed her plan’s successes in complex care integration through various workforce development initiatives, such as motivational interview training, practice coaching, team-based care webinars, and discipline-specific training. Pomerance also spoke to the challenges associated with caseload management, behavioral health clinician recruitment and retention, as well as software development for the purposes of timely data acquisition. Other speakers included Deepu George, Assistant Professor of Family Medicine, Division Chief – Behavioral Medicine, Department of Family & Preventive Medicine, UTHealth; and Deborah Weidner, MD, Vice President, Safety and Quality, Behavioral Health Network, Hartford HealthCare.
“What’s Next for Foster Care: Preparing for Dramatic Changes”
Speakers during this session discussed the Family First Prevention Services Act (FFPSA), which will allow states to use Title IV-E funding to support the prevention of foster care placement. This shift in funding and a new focus on prevention and expanded intervention will significantly change delivery models at state and local agencies. Speakers highlighted the programs in place in Maryland and New Jersey and how their agencies are reacting to FFPSA. Key themes that emerged were the stringent requirements outlined in FFPSA for using evidence-based programs and how agencies are going to navigate and coordinate with their Medicaid agencies to finance their foster care programs. Speakers included Christine Beyer, Commissioner, NJ Department of Children and Families; Alyssa Brown, Deputy Director, Innovation, Research, and Development, Office of Health Care Financing, MD Department of Health; Rebecca Jones Gaston, Executive Director, Social Services Administration, MD Department of Human Services; and Tracy Wareing Evans, Executive Director, American Public Human Services Association.
“Lessons of Medicaid Work Requirements, Premiums, and Other Forms of Community Engagement”
In this session, speakers discussed the Indiana and Arkansas work requirements and other community engagement requirements. Specifically, speakers spoke about strategies to engage patients and stressed how important it is to educate the patients and providers. Anthem, for example, used webinars, state-sponsored workshops, hospital meetings, mailings, and outreach to FQHCs to educate providers. Speakers noted that the best vehicles for outreach can vary depending on the age and limitations of the individual member. Speakers also discussed lessons learned from these early community engagement initiatives and provided success stories in helping members achieve self-sufficiency. Speakers included Natalie Angel, Healthy Indiana Plan Director, Indiana Office of Medicaid Policy and Planning; Jean Caster, HIP Program Director, Anthem Indiana Medicaid; and Ray Hanley, President and CEO of AFMC.
Investor Breakout Session
“Virtual Patient Interaction: The Future is Now”
Executives from private-equity backed digital health companies discussed the growing momentum of telehealth, with an emphasis on how new technologies are enhancing the patient-provider relationship and improving care. Outdated regulations were identified by the panelists as obstacles to implementation, for example, preventing providers from sending text messages, a preferred method of contact especially across low income populations. Panelists discussed the importance of designing and adapting products based on feedback from the patients and providers. Panelists included Abner Mason, CEO, ConsejoSano; Steve Sidel, Founder & CEO, Mindoula Health; and Neil Solomon, MD, Co-founder, Chief Medical Officer, MedZed. The panel was moderated by Marshall Jackson, Jr., Associate, McDermott Will & Emory LLP.
“The Growing Role of Medicare Advantage and the Future of Medicare”
Jonathan Blum, Managing Principal, HMA; former CMS Deputy Administrator for Medicare, addressed the growing role of Medicare Advantage in serving Medicare beneficiaries. Medicare Advantage now serves more than 21 million members, he said, or about a third of all Medicare beneficiaries. While Medicare Advantage enrollment has steadily increased, Blum noted, the rate of growth has slowed. Meanwhile, market share of health plans serving beneficiaries is steadily consolidating. He described Medicare as the largest public value-based purchasing system in the federal government because of its star ratings system. Blum noted that 4+ star plans receive a 5% bonus payment from Medicare, which translates to lower premiums, better benefits, higher enrollment and more physician engagement. The effect is that higher rated plans tend to increase their market advantage over low-rated plans, which in turn spiral downward. Blum also addressed the opportunities in the market for serving dual eligibles.
Keynote Q&A Session
“Managed Care Models for Dual Eligible Medicaid-Medicare Beneficiaries”
Speakers discussed how health plans and providers are developing integrated models that can effectively serve the more than 12 million Americans nationwide dually eligible for Medicare and Medicaid. One key theme centered on the need for solutions that address the fragmented and uncoordinated systems serving this population. Lois Simon, EVP, Policy and Programs, Seniorlink, indicated a need for fully integrated plans that address all social determinants of health when enrolling a member. Simon noted the importance of integration on the front-end for the member: e.g., one support number to call, one identification card, one book to consult, and culturally competent and meaningful plan materials. Other topics included the future of financial alignment demonstrations, capturing and applying member feedback in the delivery of care, and next steps in making care coordination less complicated. Other speakers included Matthew Behrens, Integrated Care Policy Supervisor, Virginia Department of Medical Assistance Services; Jack Dailey, HCA Coordinator, Director of Policy and Training, Consumer Center for Health Education and Advocacy, Legal Aid Society of San Diego, Inc.; and Allison Rizer, Vice President, Strategy and Health Policy – Medicare/Medicaid Integration, UnitedHealthcare Community & State.
“What’s Next for Provider-Led Medicaid Managed Care”
Mitchell Katz, MD, President and CEO, NYC Health + Hospitals, addressed the growing role and significance of providers in Medicaid managed care. Katz shared his experiences not only as a practicing physician but also as head of the largest public healthcare system in the country. Katz noted that “Providers know what’s best for patients,” he said, adding that “it’s the obligation of providers to tell health plans what the patients need.” He described prior authorizations as a form of cost containment that ironically can result in higher costs.
Keynote Q&A Session
“Innovative Care Delivery Models for High-Cost, High-Acuity Patients”
Speakers discussed their approaches to complex coordinated care for the nation’s sickest and most vulnerable individuals. Alan Cohen, CEO, AbsoluteCARE Inc., outlined his company’s integrated comprehensive approach, which assigns members primary care physicians, case managers and social and behavioral health providers – a model that has decreased emergency room visits and inpatient admissions. Sarita Mohanty, MD, Vice President, Care Coordination, Kaiser Permanente, also identified the benefits of a holistic approach to coordinated care, striving to bridge clinical care with behavioral health integration and social health needs. Other speakers included Rebecca Kavoussi, President, West, Landmark Health.