Title: Impact of the MMA on Existing Disease Management Programs and Managed Care Initiatives for the Aged and Disabled
1Impact of the MMA on Existing Disease Management
Programs andManaged Care Initiatives for the
Aged and Disabled
- Center for State Health Policy
- Rutgers, The State University of New Jersey
- Roberta Kelley
- Chief, Bureau of Health Systems Development
- Florida Agency for Health Care Administration
2MMA and Florida MedicaidFlorida Over Age 65
Population
- 15.2 Million Residents
- 17.6 percent over age 65 versus 12.4 percent
nationally - 2.9 Million Medicare Beneficiaries
-
3MMA and Florida MedicaidMedicaid Enrollment
(Estimated FY2003-04)
- 2.1 Million Eligibles
- Approximately 480,000 are dual eligibles
- 13 Billion in Expenditures
- Dual eligible account for 40 of total
expenditures - Dual eligible drug costs account for 55.5 of
total drug spend - Exempt from Managed Care
4MMA and Florida MedicaidDisease Management
Initial Statutory Direction
- Medicaid Reform Task Force
- Legislative Authorization (HIV, Asthma, Diabetes,
Hemophilia) - Legislative Authorization (ESRD, Heart Failure)
- Asthma Agreement
- ITNs for HIV, Diabetes and Hemophilia
- ITNs for ESRD and Heart Failure
- Diabetes Contract
- HIV/AIDS (except S. FL) and Hemophilia Contracts
- Legislative Authority to Expand to Other Diseases
as Necessary - COPD Pilot Contract
- ESRD and Heart Failure Contracts
- Legislative Authorization for Value-Added
Programs - Pfizer Agreement (Asthma, Diabetes, Hypertension,
Heart Failure) - Bristol-Myers Squibb Agreement (Diabetes,
Depression) - Autoimmune Center Contract
July 1997
July 1998
July 1999
July 2000
July 2001
5MMA and Florida MedicaidDM Initiative History
Dates Disease State(s) DMO(s)
8/982/00 Asthma -Integrated Therapeutics Group
5/99-6/02 Diabetes -Coordinated Care Solutions
6/99-6/04 HIV/AIDS -AIDS Health Care Foundation (With Public Health Trust of Miami-Dade/N. Broward Hospital District in S.FL)
6/99-7/01 9/00-1/03 Hemophilia -Accordant (S. FL) -Caremark (N. FL)
9/01-8/03 ESRD/CKD -RMS Disease Management
9/01-8/05 CHF -Lifemasters Supported SelfCare
8/00-12/01 COPD -CyberCare Technologies
1/02-6/04 Autoimmune Disorders -University of Florida
7/01-9/05 Diabetes, Asthma, CHF, HTN -Pfizer/Pfizer Health Solutions
5/02-6/03 Diabetes, Depression -Bristol Myers Squibb
Spring 04 Evaluation of Initiative -Contract with CorSolutions
6MMA and Florida MedicaidDM Initiative Currently
- Florida A Healthy State
- Asthma, Diabetes, Hypertension statewide CHF
Areas 8-11 - Positive Healthcare
- AIDS Healthcare Foundation, HIV/AIDS statewide
- Diabetik Smart Promotora Diabetes Program
- Health Choice Network, Dade and Broward counties
- LifeMasters Supported Self Care, Inc.
- CHF Areas 1-7
- University of Florida
- Center for Orphan Autoimmune Disorders
7MMA and Florida MedicaidMedicaid DM Enrollment
Process
- Claims Based Disease State Algorithms
- ICD-9 codes
- NDC codes
- Utilization
- Beneficiaries assigned to DM program based on
Disease State Hierarchy - Duals excluded from DM except for PAC
8MMA and Florida MedicaidDM and Long Term Care
- HIV/AIDs DM works with Home Community Based
Waiver Program - Approximately 3,200 of 5,880 enrollees are dual
eligible - Responsible for utilization review and
assessments - Reduction in Home Health and Skilled Nursing
9MMA and Florida MedicaidPart D Drug Coverage and
Impact on FL DM
- Availability of Claims Data (medical and
pharmacy) to identify beneficiaries - Coordination of Benefits
- Medicare only providers
- Lack of UR/UM measures for population
- Education of Drug Coverage
10MMA and Florida MedicaidEnrollment in Part D
- States have not been given authority to ensure
that duals are enrolled. - Duals are expected to secure Part D coverage.
- but enrollment is voluntary non selection
assignment and - although automatically enrolled, they may opt out
11MMA and Florida MedicaidChronic Care Improvement
Program
- Coverage of CHF and Diabetes
- Participation is Voluntary
- Florida is a possible site
- Strong Evaluation Component
- Scalability of Program
12MMA and Florida MedicaidMedicare Advantage
- Encouraged to provide DM
- Creation of Specialty Health Plans
- May increase DM and enhance coordination of
Medicare covered services - Medicaid services are unmanaged
13MMA and Florida MedicaidConclusion
- Short Term
- Enrollment and Coverage of Prescription Drugs
- Fragmentation as CCIP becomes operational
- Long Term
- Scalability of DM Programs
- Decision to better manage duals and integration
with long term care
14- Roberta Kelley
- Chief, Bureau of Health Systems Development
- Florida Agency for Health Care Administration
- kelleyro_at_fdhc.state.fl.us
- Ph. 850-487-2355
- Medicaid
- http//www.fdhc.state.fl.us/Medicaid/index.shtml