Creating Partnerships to Address Non-Medical Needs of Medicaid Beneficiaries with Complex Care Needs and High Costs

Publication Year: 2017
Population Focus: Complex care, Medicaid beneficiaries
Intervention Type: Partnership
Type of Literature: Grey


Insights Results

Overview of presentation

  • This is a slide deck to complement a webinar series on “Creating Partnerships to Address Non-Medical Needs of Medicaid Beneficiaries with Complex Care Needs and High Costs”
    Example: Connecticut Money Follows the Person “Housing Plus Services” Model
  • The Connecticut Medicaid reform agenda consists of 5 key elements: 1) A simplified administrative structure; 2) A fully integrated claims dataset, which enables the program to illuminate needs, influence policy direction, ensure accountability and support cost savings; 3) A strong emphasis on preventive care; 4) Focus on integration of services; and 5) Building long-term services and supports that enable true choice and integration
  • Connecticut’s agenda is enabled by a fully integrated, statewide Medicaid claims data set, development of data analytic and data match capabilities, emerging Medicaid authorities, and the State Innovation Model’s emphasis on development of value-based purchasing
  • There are 5 strategies outlined towards Connecticut’s comprehensive approach: 1) Program-wide adoption of an applied definition of person-centeredness, which can improve probability of effective and efficient provision of services by re-establishing the member and his/her values and preferences as a center point of development of health goals; 2) Integration of questions around housing stability, food security, and personal safety as threshold elements of administrative service organization (ASO) integrated care model (ICM) assessments, which can improve the probability of effective and efficient provision of services by acknowledging and attending to the facts that members cannot meaningfully engage around health goals if basic human needs are not effectively met; 3) Implementation of a range of ICM modes, which can improve the probability of effective and efficient provision of services by avoiding a one-size-fits-all disease education/management strategy by tailoring care team and care delivery approach to fit needs of involved population; 4) Implementation of health homes for individuals with serious and persistent mental illness and high Medicaid claims via Local Mental Health Authorities and social service partners, which can utilize per member per month payment to enable flexible care coordination support to attributed members by situating primary care medical services and social services connections within existing, trusted network of behavioral health providers; and 5) Requirement that federally qualified health centers (FQHCs) and accountable care organizations (ACOs) that will participate in an upside-only shared savings initiative enter into formal agreements with social services partners, which can utilize supplemental payments for enhanced care coordination and upside-only shared savings arrangements to support providers in achieving improved outcomes by acknowledging and attending to the fact that even an entity that has made extensive progress in practice transformation will benefit from close nexus with social services
  • Target populations for the agenda are all Medicaid beneficiaries, individuals with serious and persistent mental illness and high costs, market facilitation program (MFP) eligible individuals and non-dual eligible members served by FQHCs and ACOs
  • Accomplishments in Connecticut include reduction in emergency department uses, inpatient care and readmissions, and conceptions of care team and emphasis points for care coordination. Challenges include long developmental curve for projects and hurdles to cross-set data matching
  • Examples of models in Michigan include:
  • Michigan’s Medicaid Managed Care Contract Communication focuses on leveraging managed care contracting, population health management and the primary care model. Policy levers for the program’s integration with community include the use of community health workers, population health management and community collaboration project
  • The Michigan State Innovation Model (SIM)-Project is a model for structured community collaboration between healthcare partners across sectors, a model for care coordination and prioritizes addressing social determinants and population health management
  • Michigan’s Medicaid Managed Care Contract must provide or arrange for the provision of community health worker services. They must also submit and annually update multi-year plan to meet all Population Health Management contractual requirements, pursue community-based approaches to care coordination, health promotion and disease management, and measure and report on all interventions designed to impact subpopulations experiencing disparities. The Community Collaboration Project includes a community health needs assessment and community health improvement plan processes and they must report participation in approved community-led project to improve population health in each service area

    Key takeaways/implications

    • Interventions should be 1) multifaceted; 2) target root causes of barriers to healthcare access, engagement and adherence; and 3) align and leverage resources across sectors, agencies and systems
    • When states consider addressing non-medical factors, they should consider: 1) Data to understand health demographics and factors in local context; 2) The landscape (e.g., community-based organizations); 3) Leadership (e.g., health systems, providers); 4) Innovations that are building from what exists; 5) Practical solutions to interconnect physical, behavioral and community systems (e.g., provider readiness and capacity, technological supports, data governance); and 6) Available programmatic supports (e.g., policy levers, data analytics capacity, incentives and financing, and performance monitoring and measurement)
    • 1) A variety of approaches to address non-medical factors can be incorporated as part of broad state Medicaid and reform strategies; 2) The realities of each state’s policy and healthcare landscape create opportunities and challenges; 3) The state can play an important role to call for and structure new care and service models and collaborations; 4) Blending medical and non-medical approaches to BCN efforts requires building knowledge and partnerships across typically siloed “systems of care” (i.e., clinical care vs community services); 5) Multi-level data sharing capacity is a critical component for care partnerships, measuring outcomes, and value-based payment; and 5) Lessons learned for addressing non-medical factors are available from population-specific care systems