Michigan Department of Community Health
Director Olga Dazzo
Michigan’s Plan for Integrated CareNational Academy for State Health Policy
Kansas City, MissouriOctober 5, 2011
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Michigan’s Health Care Priorities
• Improve health status of Michigan citizens• Improve health care system• Lower health care costs• Implement provisions of health care reform
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Current Environment
• Medicare and Medicaid spending > $7 billion for 207,000+ duals
• State spend primarily on nursing facility care and behavioral health services
• Primarily an older female and younger male demographic
• Multiple chronic health conditionsData source: 2008 Michigan Medicaid Data Warehouse and ResDAC Medicare Data
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Current Environment
• Managed care physical health and behavioral health systems for Medicaid benefit
• Little managed care for Medicare benefit
• Waiting list for long term care HCBS
• Multiple case managers for people receiving services
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Basic Demographics
Gender Age
Under 65 Over 65 Total
Female 64,539 71,725 136,264
Male 55,268 30,155 85,423
Total 119,807 101,880 221,687Source: Michigan Medicaid Data Warehouse – 2010 Unduplicated Count of Beneficiaries
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Chronic ConditionsCondition Number of
IndividualsPercent of
Duals
Ischemic Heart Disease 70,650 34%
Diabetes 64,570 31%
Depression 53,425 26%
Chronic Heart Failure 49,496 24%
Arthritis 48,491 23%
Behavioral Health 41,863 20%
Alzheimer Related Disease 37,872 18%
Chronic Obstructive Pulmonary Disease 36,754 18%
Chronic Kidney Disease 33,058 16%
Cataract 21,852 11%
Osteoporosis 20,060 10%
Alzheimer’s Disease 19,844 10%Source: Medicare Chronic Condition Warehouse for 2009
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Multiple Conditions
0%2%4%6%8%
10%12%14%16%18%20%
Percent of Duals Population
0 1 2 3 4 5 6+
Number of Chronic Conditions
Source: Medicare Chronic Condition Warehouse for 2009
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Overview of Proposed Approach
• Provide all covered services for dually eligible beneficiaries through single contracted entity
• Feature auto-enrollment with opt out
• Design robust care coordination program with health home and person-centered focus
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Overview of Proposed Approach
• Integrate funds at the state level with full or shared risk/shared savings model
• Acuity-based capitation arrangement with contracted entities (no pre-selected model)
• Shared risk initially between Medicaid and contracted entities
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Core Program Elements
• All core Medicare and Medicaid services • Comprehensive provider network• Single standardized assessment tool• Person-centered planning• Person-centered health homes • Care coordinator or team for each participant• Family caregiver involvement
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Core Program Elements
• Strong HCBS options• Performance evaluation metrics • Quality management strategies and
measurements• Data sharing to enhance care coordination• Auto enrollment with opt out• Enrollee protections that meet Medicare and
Medicaid standards
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Stakeholder Process
• Informant Interviews
• Regional Forums
• Request for Input
• Topic-Driven Workgroups
• E-mail box
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Things to Think About (or early lessons learned)
• Prepare for difficult conversations
• Early data acquisition and analysis
• Dedicate staff for project planning and development
• Develop public relations strategy
• Listen
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Contact Information
Susan Yontz, DirectorLong Term Care Services DivisionMedical Services Administration