Download Vermont`s Dual Eligible project

Vermont’s Dual Eligible project
National Academy for State Health Policy’s
23rd Annual State Health Policy Conference
Brendan Hogan
Vermont
10/5/10
Overview
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Vermont Population Context
Global Commitment 1115 waiver
Choices for Care 1115 LTC waiver
Governor’s Blueprint for Health
Current project – VT as Medicare Plan
VT Population context
• Total state population – estimated 600,000
• Total Medicare population – est. 98,000
• Total Medicaid & RX population – est. 150,000
• Total Dual Eligible population – est. 15,000
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Global Commitment 1115 waiver
• Vermont has a first in the nation Global
Commitment 1115 Medicaid waiver
• Waiver includes all Medicaid services
except SCHIP and LTC
• http://ovha.vermont.gov/administration/200
8-global-commitment-to-health-documents
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Choices for Care 1115 LTC waiver
• Vermont has a first in the nation 1115 LTC
waiver where VT allows a choice of
nursing home or home and community
based services for LTC Medicaid eligibles
• http://www.ddas.vermont.gov/ddasprograms/programs-cfc/programs-cfcdefault-page
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Governor’s Blueprint for Health
• Governor Douglas created the Blueprint
for Health in Vermont and charged the
Vermont Dept of Health to carry out this
chronic care management initiative which
now involves multi-payer funded pilots in
several VT communities
• http://healthvermont.gov/blueprint.aspx
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Vermont is a Medicare plan
• VT would work with CMS on authority to
act as a Medicare plan
• Medicaid authority would remain with our
two 1115 waivers. Duals are in both 1115
waivers
• Financial, data, legal and programmatic
analyses are occurring right now for this
effort
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Vermont – data analysis
• Vermont’s Agency of Human Services has
contracted with JEN Associates to assist
us with analysis of Medicare and Medicaid
Claims data http://www.jen.com/
• Claims analysis will include aggregate
PMPM analyses for entire population as
well as 4 subgroups
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Vermont data analysis - subgroups
• Analysis of Medicare and Medicaid claims
data will be for the following subgroups:
– LTC Medicaid
– CRT – Community Rehabilitation and
Treatment program (Mental Health)
– Developmental Services
– All other Aged Blind and Disabled
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Purpose of data analysis
• Create aggregate PMPM for all dual
eligibles as well as the 4 cohorts
• Apply the HCC – Hierarchical Clinical
Classification standards to the data to
assist the state in the data analysis and
subsequent negotiations with CMS
• http://www3.cms.gov/HealthCareFinancing
Review/downloads/04Summerpg119.pdf
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Vermont is a Medicare plan
• Model would include expanding upon
current Blueprint multipayer effort in
Vermont where existing case management
systems for Medicaid would be directly
linked to Blueprint Community Health
teams
• Better community based coordinated care,
we believe, will save both Medicare and
Medicaid money and be more effective
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Vermont is a Medicare plan
• Discuss with CMS:
– State is at risk
– All Duals are included
– Passive enrollment with an opt out provision
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Vermont is a Medicare Plan
Discuss with CMS:
– Current and previous discussions with
providers and advocates in Vermont
– Shared savings options
– Health care reform offers opportunities for a
model like this to work for both a state and
CMS
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Questions
Brendan Hogan, MSA
Acting Commissioner
VT Dept. of Disabilities, Aging and
Independent Living
(802) 241-2401
[email protected]
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