Medicaid Cost Containment Reducing prescription drug abuse Strategies Presentation Eligibility changes asset tests, reducing or eliminating outreach activities; – – Seema Verma and Rob Dalmer, reporting changes, etc. SVC cont. Quality Initiatives Complex case management, outreach programs, care – management, reducing and abuse. Managing high cost enrollees Program integrity initiatives such as with Maine’s Medicaid Fraud – Recovery Unit Reimbursement reforms such as limiting reimbursement for potentially – preventable events, C-section reimbursement, provider taxes, etc. long-term strategies (3-5 years) Value based purchasing managed care, health homes, accountable care – organizations additional information was requested regarding which – states have been successful in implementing managed care systems (are they rural or more urban, impact of managed care in other states? Health Information Technology allows better coordination, reduction in – duplication of services and additional funding made available to states through ARRA for initiatives such as payment incentives for implementation of electronic health records Managing duals better coordination between Medicaid and Medicare – Managing long-term and high cost populations by integration with Medicare Following the discussion a worksheet was distributed Medicaid Cost “Maine Containment Strategy Summary” with the intent to help members prioritize/narrow Maine’s focus. Members felt additional information and discussion was needed prior to this exercise. Items discussed/information requested: Enhanced management of developmental disabilities more information – regarding Maryland’s Children’s anti-psychotic medications More discussion regarding mid-term strategies such as preventative Rob and DHHS staff will provide programs around high risk pregnancies implemented in North Carolina and information for discussion at the Indiana meeting scheduled for October 9, Both consultants felt risk was essential in for-profit markets and reward Room 228, State House incentives could drive provider and health plans to improve/provide services It was felt perverse incentives drive higher use of services
Medicaid Cost Containment Strategies Presentation – Seema Verma and Rob Dalmer, SVC cont. Reducing prescription drug abuse Eligibility changes – asset tests, reducing or eliminating outreach activities; reporting changes, etc. Quality Initiatives – Complex case management, outreach programs, care management, reducing and abuse. Managing high cost enrollees Program integrity initiatives – such as with Maine’s Medicaid Fraud Recovery Unit Reimbursement reforms – such as limiting reimbursement for potentially preventable events, C-section reimbursement, provider taxes, etc. long-term strategies (3-5 years) Value based purchasing – managed care, health homes, accountable care organizations – additional information was requested regarding which states have been successful in implementing managed care systems (are they rural or more urban, impact of managed care in other states? Health Information Technology – allows better coordination, reduction in duplication of services and additional funding made available to states through ARRA for initiatives such as payment incentives for implementation of electronic health records Managing duals – better coordination between Medicaid and Medicare Managing long-term and high cost populations by integration with Medicare Following the discussion a worksheet was distributed “Maine Medicaid Cost Containment Strategy Summary” with the intent to help members prioritize/narrow Maine’s focus. Members felt additional information and discussion was needed prior to this exercise. Items discussed/information requested: Enhanced management of developmental disabilities – more information regarding Maryland’s Children’s anti-psychotic medications More discussion regarding mid-term strategies such as preventative programs around high risk pregnancies implemented in North Carolina and Indiana Both consultants felt risk was essential in for-profit markets and reward incentives could drive provider and health plans to improve/provide services It was felt perverse incentives drive higher use of services Rob and DHHS staff will provide information for discussion at the meeting scheduled for October 9, Room 228, State House