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Suzanne Fields, MSWTechnical Assistance Collaborative
Accelerating Reform Initiative Madison, WIFebruary 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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State Level Medicaid Priorities and Pressures
Integrating care
Improving quality
Controlling costs
3
Typical Approaches to Medicaid Cost Containment
Medicaid Enrollment
Services
Rates
Utilization
4
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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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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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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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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