ALTCI Actuarial Study June 22, 2005. Mercer Government Human Services Consulting 2 Actuarial Study Objectives Determine key cost drivers Identify financing.

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<ul><li><p>ALTCIActuarial StudyJune 22, 2005</p><p>Mercer Government Human Services Consulting</p><p>Actuarial Study ObjectivesDetermine key cost driversIdentify financing options that promote the goals of ALTCIRecommend a rate structure that will best match payment to the risk of the enrolled population</p><p>Mercer Government Human Services Consulting</p><p>MethodologyReview historical Medi-Cal and Medicare CY1998-2000 FFS dataAdjust data to include only populations and services expected to be covered under ALTCIProject data forward to CY2007 by category of serviceAdjust data for significant program changes including Medicare Part D</p><p>Mercer Government Human Services Consulting</p><p>CY2000 DataSan Diego CountyNursing Home Residents, MSSP, DD, IHSS, and Home Care (HC) account for 30 percent of the total ALTCI membership in San Diego, but 74 percent of the total San Diego Medi-Cal expenditures.</p><p>Mercer Government Human Services Consulting</p><p>San Diego CountyCY2000 Dually Eligible vs. Medi-Cal Only ABD Membership</p><p>Mercer Government Human Services Consulting</p><p>San Diego CountyDually Eligible vs. Medi-Cal Only CY2000 PMPM ALTCI Medi-Cal Costs</p><p>Mercer Government Human Services Consulting</p><p>San Diego CountyElderly vs. Disabled Membership</p><p>Mercer Government Human Services Consulting</p><p>Alameda, Contra Costa, and San Diego CountiesCY19982000 Medi-Cal CostsHigh Cost Chronic Conditions</p><p>Mercer Government Human Services Consulting</p><p>San Diego CountyCY2000 Medi-Cal ALTCI PMPM Costs</p><p>Mercer Government Human Services Consulting</p><p>Preliminary ResultsKey Cost DriversSetting Nursing Home vs. CommunityFrailty Nursing Home Certifiable/At Risk vs. WellMedicare Status Dually Eligible vs. Medi-Cal OnlyCategory of Assistance Aged vs. DisabledChronic High Risk Conditions TBD</p><p>Mercer Government Human Services Consulting</p><p>Preliminary RecommendationsReimbursement needs to be sufficiently sophisticated to promote program goalsIncentives should be included to promote increased community based servicesSavings achievable through more appropriate use of hospital, emergency room and nursing home servicesAdministrative costs should be reflected in rates with sufficient consideration of start up costsIncreased care management should be supported and funded</p><p>Mercer Government Human Services Consulting</p><p>Preliminary Recommendations (continued)Implement early reinsurance or risk sharing Capitated model should allow for flexibility of both Medi-Cal and Medicare funding sources</p><p>Mercer Government Human Services Consulting</p><p>Next StepsComplete projectionsAssess adequacy of Medicare reimbursementFinalize recommended rating structureSubmit final report and recommendations</p></li></ul>


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