Kaiser Family Foundation Survey on State Medicaid Managed Care ...

the chronic condition (e.g., asthma, diabetes, congestive heart failure, etc.), but programs have evolvedtoward more comprehensive management of the individual’s total health care needs.Thirty-nine states reported that they operate DM and/or CM programs. Nineteen of these statesindicated that their programs were integrated into or carried out by the states’ MCOs; 12 indicated thatthe initiatives were part of a PCCM program.Many states plan to elect the new “health home”option; most will claim the enhanced federal match foran existing program. The ACA established a new stateplan option to provide “health homes” for Medicaidbeneficiaries with chronic conditions. Under the option,designed to enhance coordination and integration ofprimary, acute, behavioral health, and long-term servicesand supports, a 90 percent federal match is provided fortwo years, for health home services, such ascomprehensive care management, care coordination,and health promotion provided by a designated healthhome provider or team.Twenty-two states said they plan to elect the new option.Another 19 states were uncertain whether they wouldelect the option; four plan not to do so.A number of states report ACO initiatives in some stageof development. The ACA established the MedicareShared Savings Program to facilitate coordinated care forMedicare beneficiaries through “Accountable CareOrganizations” (ACO) comprising providers, hospitals andsuppliers. ACOs are expected to create incentives forproviders and insurers to work together to treat anindividual patient across care settings, including doctor’soffices, hospitals, and long-term care facilities. ThePractices participating in Massachusetts’ Patient-Centered Medical Home initiative mustimplement and master 12 core competencies(e.g., patient/family centeredness, multidisciplinaryteam-based approach to care), andmust populate patient registries, attend LearningCollaboratives, meet regularly with MedicalHome Facilitators, provide clinical CM servicesthrough a licensed nurse, achieve NCQA Level 1Plus recognition, participate in a formalevaluation, and meet other milestones.The Texas Medicaid Wellness Program (effectiveMarch 1, 2011) is a comprehensive CM program(with no disease exclusions) offered to high-costand/or high-risk FFS clients. Benefits includediabetic education, nutritional counseling, andvalue-added services such as Weight Watchersfor obese clients. Provider incentives include acomprehensive provider portal where providerscan view patient summaries, claims data, careplans, and patient education materials andpractice support facilitators, who provide practiceimprovement tools and training and assist withPatient-Centered Medical Home certification.MCOs also offer DM and CM services to clientswith one or more of the five main chronicconditions.Medicare Shared Savings Program will reward ACOs that lower growth in health care costs whilemeeting performance standards on quality of patient care.Nine states reported having an ACO initiative underway, planned, or under development (California,Colorado, Connecticut, Indiana, Maine, Minnesota, Oklahoma, Vermont, and Washington). Threeadditional states (Massachusetts, New Jersey and Utah) indicated that legislation had been proposed inthe 2011 legislative session to begin an ACO pilot or to require Medicaid reimbursement to ACOs.Appendix 13 provides a state-by-state summary of initiatives to improved quality and care coordination.Colorado is implementing a PCCM program that incorporates an Accountable Care Collaborative (ACC) design toimprove the client/family experience and access to care, and establish accountability for cost management andhealth improvement. By integrating the principles of a Patient-Centered Medical Home, applying best practices incare coordination and medical management, and combining access to client and resource utilization data, RegionalCare Collaborative Organizations (RCCOs) will become partners in the state’s efforts to move toward an outcomesbased,efficient, health improvement model of care. Central to the ACC program is the interaction among three keyroles: Primary Care Medical Providers are required to deliver accountable care; RCCOs are responsible for ensuringaccountable care; and the Statewide Data and Analytics Contractor is responsible for bringing a new level ofinformation and data analytics to Medicaid, providing insight into variations within and across RCCOs, benchmarkingacross key performance indicators, and facilitating health information exchange between the state and the RCCOs.4242 00