Center for Health Care Strategies
Johns Hopkins University
School of Public Health
November 7, 2013
Shannon McMahon, Director
Michelle Soper, Senior Program Officer
Center for Health Care Strategies
www.chcs.org
A non-profit health policy resource center dedicated
to improving health care services for Americans
receiving publicly financed care
►
Priorities: (1) enhancing access to coverage and services; (2) improving
quality/delivery system reform; (3) integrating care for people with
complex needs; and (4) building Medicaid leadership and capacity.
►
Provides: technical assistance for stakeholders of publicly financed care,
including states, health plans, providers, and consumer groups; and
informs federal and state policymakers regarding payment and delivery
system improvement.
►
Funding: philanthropy and the U.S. Department of Health and Human
Services.
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Select CHCS National Initiatives
Enhancing Access
to Coverage and
Services
State Health Reform
Assistance Network
Charity Care Affinity
Group
Improving
Quality/Delivery
System Reform
State Innovation
Model Resource
Center*
Aligning Forces for
Quality
Advancing Medicaid
Accountable Care
Organizations: A
Learning Collaborative
Integrating Care for
People with
Complex Needs
Complex Care
Innovation Lab
Integrated Care
Resource Center –
Dual Eligible
Demonstrations*
Building
Medicaid
Leadership
and Capacity
Medicaid Leadership
Institute
California Department
of Health Care
Services Academy
Medicaid Health
Homes Program
Design*
*Federally-funded initiatives
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Examples of CHCS Projects

Complex Care Innovation Lab – Convening national health care innovators
to explore ways to improve services for the highest-need, highest-cost
individuals receiving publicly financed health care.
► REACH: 11 innovative organizations in 10 states and Washington, DC

State Innovation Model – Working with states to design and/or test their
models for statewide care delivery and payment reform aligning with the
Triple Aim of improved health, improved patient experience, and reduced
costs.
► REACH: 25 states, ≈ 43 million beneficiaries

Medicaid Leadership Institute – Enhancing the leadership capacity of
competitively selected Medicaid directors to help them transform their
programs into national models for high-quality, cost-effective care.
► REACH: 22 states, 40 million beneficiaries; representing roughly 2/3 of the
nation’s total Medicaid population.
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CHCS is leading national Medicaid efforts to:
► Improve access and coverage to Medicaid services
particularly for vulnerable populations.
► Instill value-based purchasing principles and reward quality.
► Develop innovative care models for the highest-need, highestcost patients with multiple chronic illnesses.
► Integrate Medicaid and Medicare services and financing for
the dual eligibles.
► Leverage the program’s purchasing strength to help drive
quality improvements across public and commercial payers.
Why States?
• States can be a driving force because they
►
Pay for a large percentage of health care and have a major
stake in reducing avoidable costs
►
Have regulatory powers over providers and payers
►
Administer/regulate public health and social services
►
►
Can integrate state health information exchange
infrastructure
Can convene multiple parties
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Medicaid: Many Vital Roles in Our Health Care
System
Health Insurance Coverage
31 million children and 16 million
adults in low-income families; 16
million elderly and persons with
disabilities
Long-Term Care
Assistance
Assistance to Medicare
Beneficiaries
9.4 million aged and disabled —
20% of Medicare beneficiaries
1.6 million institutional
residents; 2.8 million
community-based residents
MEDICAID
Support for Health Care System
and Safety-Net
16% of national health spending; 40% of longterm care services
State Capacity for Health Coverage
Federal share ranges 50% to 83%; For
FFY 2012 ranges from 50% to 74.2%
SOURCE: Kaiser Commission on Medicaid and the Uninsured, 2012.
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Medicaid Basics: Program Size & Expenditures
Note: This assumes all states expand Medicaid by 2020
SOURCE: Centers for Medicare & Medicaid Services, National Health Expenditure Projections 2010-2020, 2011. p.2 available at: https://www.cms.gov/Research-StatisticsData-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/proj2010.pdf
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Medicaid ‘s Growing Role as a
Powerful Purchaser
• With the Medicaid expansion, there are new powerful incentives for
Medicaid to become a smarter purchaser
►
►
►
Federal and state budget pressures and imperatives
Medicaid stakeholders frequently look to the Triple Aim as they
consider policy changes – health care that is delivered at the right time,
in the right setting, achieving the right outcome
National efforts to contain cost look toward multipayer strategies:
Medicare, Medicaid, private market coverage (e.g., State Innovation
Models)
• Medicaid is a major driver of these imperatives and will continue to be
looked to as a place to deliver value through smarter purchasing strategies
Source: Centers for Medicare & Medicaid Services, National Health Expenditure Projections 2011-2021, 2012. p.2 available at: http://www.cms.gov/Research-StatisticsData-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2011PDF.pdf.
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Medicaid’s Purchasing Power
As the largest
Poor health care
purchaser of health
Medicaid serves
quality is an issue
insurance, Medicaid
33% children
more than 60
for all Americans;
can leverage its
million
Many people with however, the gap purchasing power to:
Americans –
is substantially
chronic illnesses
soon to be 80
greater for
Access performance
and disabilities
Medicaid
data
million
Many frail elderly
beneficiaries
41% newborns
Identify and address
gaps in quality
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Medicaid Fast Facts
67 million
$440 billion
7 - 11 million
41%
1 in 3
57%
5%
People in the United States with Medicaid coverage.
State and federal Medicaid spending for FY 2012.
Additional Medicaid/CHIP beneficiaries after 2014, pending state decisions on
Medicaid expansion.
Births in the United States covered by Medicaid.
Children in the United States covered by Medicaid.
Medicaid beneficiaries under 65 who are from diverse racial/ethnic groups.
Medicaid beneficiaries, many with chronic illnesses and disabilities, accounting for
55% of total Medicaid spending.
49%
Medicaid beneficiaries with disabilities diagnosed with mental illness.
43%
Total long-term care costs in the United States financed by Medicaid.
39%
Percentage of Medicaid dollars spent on Medicare-Medicaid enrollees.
72%
Medicaid recipients who are enrolled in managed care.
21
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MEDICAID STATE OF PLAY:
States Expanding Coverage to Adults <138% FPL
As of October 22, 2013. Source: Advisory Board. “Beyond the pledges: Where the states stand on Medicaid.”
http://www.advisory.com/Daily-Briefing/Resources/Primers/MedicaidMap#lightbox/2/
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