medicaid in a new era: proven solutions to enhance quality and reduce costs

8/6/2019 Medicaid in a New Era: Proven Solutions to Enhance Quality and Reduce Costs

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PARTNERSHIP TO FIGHT CHRONIC DISEASE

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Rising rates of chronic disease pose a significant and unsustainable

burden on us as individuals and as a nation. Our ability to bend the costcurve sustainably depends upon our ability to improve health in America

by better preventing and managing chronic disease.

Educatethe public about chronic disease and potential solutions

for individuals and communities

MobilizeAmericans to call for change in how governments,

employers, and health institutions approach chronic disease

Challengepolicymakers on the health policy changes that arenecessary to effectively fight chronic disease


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MEDICAID: THE PERFECT STORM

Projected combined state deficit in FY2012 =

$125B

Projected Medicaid spending FY2012 =

$195B

Enrollment to rise 35% over 10 years, including 16Mfrom Affordable Care Act expansion

More than 60% of acute care spending remains infragmented feeforservice system

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THE CHRONIC DISEASE PROBLEM

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Chronic diseasesare the leadingcauses of death

and disability in theUnited States and

account for the vast

majority of healthcare spending.

They affect the

quality of life for 133million Americans

and is responsible forseven out of every

ten deaths in the U.S.

killing more than1.7 million Americansevery year.

Chronic diseasesaccount for morethan 75 cents ofevery dollar we

spend on health carein this country. In

2007, this amountedto $1.65 trillion.

The United States cannot effectively address escalating health

care costs without addressing the problem of chronicdiseases.US Centers for Disease Control and Prevention


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INCREASING DEMANDS ON HEALTHCARE

Cancer

DiabetesHeart Disease

Asthma

$0.83 of every dollar spent in Medicaid goes to treat

highly preventable and manageable chronic diseases

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FOUR KEY AREAS OF OPPORTUNITY

Cool thehot spots

Fill costlygaps

Promotecoordinated

care

Enhance

adherence

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1. COOLING THE HOT SPOTS

Though more than 60 percent of adult Medicaid enrollees

have a chronic or disabling condition........a mere 4 percent of Medicaid enrollees absorb half of all

Medicaid funding.

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Personalizedaction plans

Responsibilityand

accountability

for outcomes

Teambased,coordinated

care that

supports selfmanagement

Integratingwith

community

basedresources

Regularmonitoring

and followup

PROVEN INTERVENTIONS


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2. FILLING COSTLY GAPS

Feeforservice (FFS) System

Gaps in continuum of care

High rate of readmission within 30 days

Disconnect among patients receivingMedicaid and Medicare

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3. ENHANCING ADHERENCE

One in fourAmericans do not

follow directions in

taking medications

3 out of 4 Americans

admit to having not

taken their

medicines asprescribed at some

point9

Nearly twothirds of allmedicationrelated

hospital admissions have

been attributed to poor

adherence

Poor medication

adherence costs more

than $100 billion a year

nationwide


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4. PROMOTING COORDINATED CARE

Pursuing working models incoordinated care

Integrated medical practices Medical home models

Growth in Accountable Care

Organizations Medicaid health plan models

Community Health Teams 10


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SUPPORT IN THE AFFORDABLE CARE ACT

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Medicaid medical homes (section 2703). Enhanced 90percent match for twoyears when adopt (throughstate plan amendment) team based care coordination

Need to get Medicare involved dual eligibles and feeforservice Medicaid.

Innovation Center potential source for partnering.

Waiver process for coordinated longterm care

States need to act now to create care coordinationand prevention infrastructure to manage risingprogram costs


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TURNING THE TIDE

Improving overall health is the bestway to improve our health care costs. 12

The smoking rate of Medicaid recipients is approximately 53

percent higher than in the general US population

Smokingattributable costs to the states under Medicaid were$22 billion in 2004

Medicaid also has a much higher prevalence of obesity thanother health insurance providers and pays more for inpatient

and outpatient services and medication for obese patients


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CAPITALIZING ON OPPORTUNITY

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Adopting evidencebasedcare coordination

throughout the Medicaidprogram has the potential to

save a total of nearly $250Billion over the next decade

Entitlement reformbothMedicare and Medicaid

need to include nationalprogram to prevent chronicdisease and more effective

care coordination. Both havelarge potential savings.


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For more information, please go to:

www.fightchronicdisease.org

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medicaid in a new era: proven solutions to enhance quality and reduce costs

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