Section 1115 Waiver Renewal Stakeholder Workgroup Update - California

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Section 1115Waiver RenewalStakeholder WorkgroupUpdateMari Cantwell, Chief Deputy Director, Health Care ProgramsWendy Soe, Senior Advisor for Policy DevelopmentDepartment of Health Care ServicesDecember 03, 2014

Workgroups Update2

Workgroups Update Five separate workgroups assembled to develop concepts on:–––––1) Medicaid-funded Shelter/Housing2) Provider/Managed Care Plan incentive programs3) a Delivery System Reform Incentive Program (DSRIP)4) Workforce Development5) Safety Net Reform – Disproportionate Share Hospitals (DSH)/Safety NetCare Pool (SNCP) bundled payments 3-5 sessions on each topic between November 2014 –February 2015 A one-day session with a broad stakeholder distribution is planned in lateJanuary for the Department to solicit input on a financing strategy forfederal-state shared savings under the 1115 Waiver. Two other concepts potentially linked to waiver: redesign of the CaliforniaChildren's Services (CCS) Program and Federally Qualified Health Centers(FQHC) payment reform will continue on separate stakeholder/conceptdevelopment efforts already underway.3

WorkgroupsDSH/SNCP SafetyNet Financing Next (First) Meeting: Dec. 9 3 TotalWorkforceDevelopment Next Meeting: Dec. 11 3 TotalPlan/ProviderIncentives Next Meeting: Dec. 15 3 TotalMedicaid-fundingHousing/Shelter Next Meeting: Dec. 16 4 TotalDSRIP 2.0 Next Meeting: Dec. 19 5 Total4

Early Areas of InterestAlignment of metrics acrossproviders/plans/deliverysystemsDeveloping sharedsavings/accountable carearrangements betweenentities towards betterquality, cost effective careBehavioral health integrationstrategies within each of theworkgroup concept areasExpanding workforce capacityand access to beneficiaries byincenting new providers toserve Medi-Cal and forexisting providers to serveadditional Medi-Cal patientsStrategies to maximize federalfinancial investment underthe authority of section 1115waiversEvaluation design for deliverysystem transformation5

Highlights from First MeetingsMedicaid-funded Housing/Shelter (Nov. 4, 2014) DHCS Long-Term Care Division and Corporation for SupportiveHousing (CSH) provided information on 1115 Wavier renewalprocess, initial concepts, with a focus on defining housing andhousing-based servicesPlan/Provider Incentives (Nov. 12, 2014) Framed discussion around potential incentive constructs: DHCS to Medi-Cal Managed Care plans (MCPs); MCPs tocontracted entities/providers; MCPs to county behavioral health Potential pay-for-performance structures, sharedsavings/accountable care arrangements6

Highlights from First Meetings(continued)DSRIP 2.0 (Nov. 13, 2014) Framed discussion around: successes of the current DSRIP, thelogistics of non-federal share in CA, looking forward at DSRIP 2.0 asthe first 5-yr DSRIP up for renewalWorkforce Development (Nov. 20, 2014) Framed discussion around three goals, for a wide range of providertypes: Increase the number of new health workers to serve in medicallyunderserved areas or to serve more Medi-Cal beneficiaries Develop innovative ways to address whole person care to addressphysical and mental health and substance use disorder care needs Create financial and other incentives to encourage greatercommitment to serve the Medi-Cal population7

Workgroups Update (cont.) DHCS will be engaging CMS throughout theconcept development and stakeholder process Workgroup meeting summaries posted onDHCS Waiver Renewal webpage Comments can continue to be submitted tothe Waiver Renewal inbox Public summary of stakeholder input as wellas letters to the Department made availableon website8

Federally Qualified HealthCenters (FQHCs) PaymentReform&CA Children’s Services (CCS)Program Redesign Update9

FQHC Update: Payment ReformObjectivesTransform how careis provided atFQHCs Increased accessand capacity Allow for additionalflexibilities in caredeliveryBuild upon thestate’s existingorganized deliverysystemImprove patienthealth outcomes Align incentives forpatient-centeredcare Strengthen MCPFQHC relationshipsEnhanceTest a value-basedAlternativePaymentMethodology (APM)and bend the costcurvedata quality Data sharingbetween MCPs,FQHC and the state Reporting andtracking measuresfor evaluation andratesetting10

FQHC Update:Current and Upcoming EffortsTo date, DHCS has provided technical assistance to FQHCs and Managed Care Plans(MCPs) in convening workgroups to develop a viable Alternative PaymentMethodology (APM) pilot.Workgroups on key components: data analysis of payment and claims dataalternative methods of care deliverytriggers for reconciliationevaluation metrics: What does successful practice transformation look like?Capitation rate developmentLegislation and Federal approval11

Path to SuccessConsensusbetween plans,health centers, andthe Administrationon pilot designEvaluation ofpracticetransformationLegislative andfederalauthorityViableratesettingmethodology12

CCS UpdateDHCS has assembled a CCS Redesign Stakeholder Advisory Board (RSAB)composed of individuals from various organizations and backgrounds withexpertise in both the CCS program and care for children and youth with specialhealth care needs.Meetings begin in December 2014 and run through approximately July 2015.This process will also include topic-specific technical workgroups composed ofexperts in key issues.The fundamental goals of the redesign process are to: 1) improve care andoutcomes for children and youth with special health care needs by ensuring thatthey receive coordinated care and 2) identify indicators that will measure qualityin order to improve care for these children and their families.The DHCS has no predetermined preference for health care delivery changesor improvements and is looking to the stakeholder process to provide viablerecommendations that would best benefit the CCS population.13

Technical ConsultantsGenerally providing assistance to DHCS in: Researching national and state issues related to the initial set of Waiver concepts Presenting/ facilitating discussion at stakeholder workgroup meetings Contributing content for Waiver Renewal submissionDHCS looking to bring on additional consultants with familiarity on1115 Waivers and Medicaid financing to help with STC and BudgetNeutrality developmentDHCS also working with departments under CA HHS Agencyaround specific concepts areas through the stakeholderworkgroups14

SAC Meetings in 2015Will continue through the current WaiverAnticipate 4 meetings in 2015Tentative dates set Feb 2015 - Oct 2015Will continue discussion on progress of current BTR Waiver programs andhealth care reform implementationWill routinely provide update on status of Waiver Renewal efforts at SACmeetings15

Foundation SupportCA foundations (Blue Shield of CA Foundation, CaliforniaHealthCare Foundation, The California Endowment)continue to be supportive of DHCS initiatives that seek toimprove the health of our beneficiaries. Among the manyinitiatives they help support are:1115 WaiverRenewalSACFQHC PaymentReform16

Questions/ and aiverRenewal.aspx17

Highlights from First Meetings (continued) DSRIP 2.0 (Nov. 13, 2014) Framed discussion around: successes of the current DSRIP, the logistics of non-federal share in CA, looking forward at DSRIP 2.0 as the first 5-yr DSRIP up for renewal. Workforce Development (Nov. 20, 2014) Framed discussion around three goals, for a wide range of .

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