Impact of the MMA on Existing Disease Management Programs and Managed Care Initiatives for the Aged and Disabled - PowerPoint PPT Presentation

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Impact of the MMA on Existing Disease Management Programs and Managed Care Initiatives for the Aged and Disabled

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Title: Impact of the MMA on Existing Disease Management Programs and Managed Care Initiatives for the Aged and Disabled


1
Impact 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

2
MMA 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

3
MMA 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

4
MMA 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
5
MMA 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
6
MMA 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

7
MMA 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

8
MMA 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

9
MMA 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

10
MMA 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

11
MMA 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

12
MMA 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

13
MMA 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
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