Section 1115 Medicaid Waiver RenewalSafety Net Financing

Expert Stakeholder Workgroup #2Mari Cantwell

Department of Health Care ServicesJanuary 12, 2015

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Workgroup Agenda

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Status Update

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Recap of Meeting #1

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Recap of Meeting #1 (continued)

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Bridge to Reform Waiver DSH/SNCP Allocations

Bridge to Reform Waiver DSH/SNCP Allocations

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BTR DSH/SNCP Allocations (DY 10 – FY2014/15 Estimates)

• Current DSH/SNCP allocation methodologies for DPHs:– DSH allocation formula (Estimated Federal Funds: $1,176M)

• Specific allocation amount ($12M)

• Per discharge amounts ($179.7M) :– Medi-Cal: $750 per discharge ($122.6M; 163,465 discharges))

– LIHP: $900 per discharge ($15.8M; 17,506 discharges)

– Uninsured : $1,100 per discharge ($41.3M; 37,577 discharges)

• Remainder allocated using pro-rata distribution based on DSH eligible costs - uncompensated Medi-Cal and Uninsured costs ($984.6M)

– SNCP allocation formula (Estimated Federal Funds: $236M) :• Pro-rata allocation according to SNCP eligible uninsured costs

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Global Budget /Coordinated Care for the

Uninsured

Global Budget /Coordinated Care for the Uninsured

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Key Goals/Concepts

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Methodology

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Methodology (continued)

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Service Categories

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Category 1: Face-to-Face Outpatient Visits

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Category 2: Technology-Based Outpatient Encounters

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Category 3: Non-Office Based Outpatient Encounters

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Category 4: Preventive Health, Education, Care

Management, and Patient Support Encounters

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Category 5: Inpatient/Facility Stays

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Service Categories/Point Valuation

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Hypothetical Example

Hypothetical Example

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Hypothetical Example

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Hypothetical Example (continued)First, establish the “threshold point value” for the system by assigning relative values based on how the current system works and traditional/non-traditional services are or are not reimbursable

Category Service Units Points per Unit Total Points1 Outpatient primary care visit 1,000 10 10,000 1 ER visit 3,000 25 75,000 2 Telephone consultation 500 - - 3 Paramedic treat & release 700 - - 3 Community health worker encounter 500 - - 4 Support group 100 - - 5 Inpatient day 2,500 40 100,000

185,000

Current System/Services (Hypothetical Points)

Threshold Point Value

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Hypothetical Example (continued).Next, after valuing services to recognize high-value of coordinated care and value of non-traditional services, measure total points based on actual services provided in the given year.

Category Service Units Points per Unit Total Points1 Outpatient primary care visit 1,750 20 35,000 1 ER visit 1,750 20 35,000 2 Telephone consultation 1,000 15 15,000 2 Telemedicine 1,000 15 15,000 2 eConsult 300 10 3,000 3 Paramedic treat & release 700 10 7,000 3 Community health worker encounter 750 10 7,500 4 Support group 150 5 750 5 Inpatient day 2,000 35 70,000

188,250

3,250

Future System/Services with Services Valued to Reflect Goals

Total PointsAmount above/

(below) threshold

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Evaluation and Accountability

Evaluation and Accountability

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Evaluation/Accountability

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Evaluation/Accountability (continued)

Resource Allocation – measures of the shift in the balance of carePotential metrics

– Ratio of primary to specialty care visits– Ratio of new to follow-up appointments within specialty care– Average time to discharge from specialty care– Ratio of primary care to emergency room/urgent care visits– Mental health/substance use disorder visits– Inpatient stays related to ambulatory sensitive conditions

Workforce involvement – investment in alternative uses of workforce to expand access and provide higher quality care for lower long term costsPotential metrics

– Use of non-traditional workforce classifications (e.g. CHWs)– Expansion of roles/responsibilities (within scope of practice) for traditional

workforce classifications

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Questions and Discussion

Questions and Discussion

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Key Questions

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Next Steps

Next Steps

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