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Suzanne Fields, MSW Technical Assistance Collaborative Accelerating Reform Initiative Madison, WI February 11, 2010

Suzanne Fields, MSW Technical Assistance Collaborative Accelerating Reform Initiative Madison, WI February 11, 2010

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Page 1: Suzanne Fields, MSW Technical Assistance Collaborative Accelerating Reform Initiative Madison, WI February 11, 2010

Suzanne Fields, MSWTechnical Assistance Collaborative

Accelerating Reform Initiative Madison, WIFebruary 11, 2010

Page 2: Suzanne Fields, MSW Technical Assistance Collaborative Accelerating Reform Initiative Madison, WI February 11, 2010

Highlights of Reform Opportunities

Wellstone-Domenici Mental Health Parity and Addictions Equity Act

Health Care Reform

While still early implementation (parity act) or under debate (health care reform), common needs are recognized for reform

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Page 3: Suzanne Fields, MSW Technical Assistance Collaborative Accelerating Reform Initiative Madison, WI February 11, 2010

State Level Medicaid Priorities and Pressures

Integrating care

Improving quality

Controlling costs

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Page 4: Suzanne Fields, MSW Technical Assistance Collaborative Accelerating Reform Initiative Madison, WI February 11, 2010

Typical Approaches to Medicaid Cost Containment

Medicaid Enrollment

Services

Rates

Utilization

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Page 5: Suzanne Fields, MSW Technical Assistance Collaborative Accelerating Reform Initiative Madison, WI February 11, 2010

IntegrationSystem –level changesMedical homes, integrated care teams,

accountable care organizations /health centers Electronic health records, telemedicine, HIT

Practice-level changes Using electronic health records and IT Working with primary care / health centers Virtual teams /new roles on teams

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Page 6: Suzanne Fields, MSW Technical Assistance Collaborative Accelerating Reform Initiative Madison, WI February 11, 2010

Improving QualitySystem and practice level changes

Measuring an individuals improvement/outcomes

Measuring provider performance Measuring client outcomes across a continuum of

services

Promoting efficiencies

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Page 7: Suzanne Fields, MSW Technical Assistance Collaborative Accelerating Reform Initiative Madison, WI February 11, 2010

Managed Care

Currently, 70% of Medicaid enrolled individuals are covered under a managed care arrangement

Managed care enrollment will rise under HCR

Medicaid reliance on managed care, coupled with changes in coverage under private insurers, will result in numerous rules/processes to learn

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Page 8: Suzanne Fields, MSW Technical Assistance Collaborative Accelerating Reform Initiative Madison, WI February 11, 2010

Managed Care (cont)Providers and managed care

Black hole/mystery box Medicaid agencies and MCO’s will have

varying knowledge about SA Establish relationship with MCO3 important words and what they really meanLearn the rules and processes and teach it to

staff

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