ADAP programs & the ACA Marketplace; ADAP programs & the ACA Marketplace;

how can we make them work together? how can we make them work together?

Strategies from the Florida experienceStrategies from the Florida experience

Joey Wynn – Co Chair, FHAANJoey Wynn – Co Chair, FHAANCommunity Relations Director, Empower U Community Relations Director, Empower U

(Miami - Dade County’s newest FQHC) (Miami - Dade County’s newest FQHC)

ADAP Advocacy Association (aaa+) 2014 ADAP Summit , April 14th 2014 Westin Hotel, Washington D.C.

Essential Elements of a Strategy to Essential Elements of a Strategy to Leverage ACA plans for ADAP Client Leverage ACA plans for ADAP Client Transitions: Transitions:

Create constructive dialogue with ADAP staff Create constructive dialogue with ADAP staff

Get funding data & enrollment figures etc…Get funding data & enrollment figures etc…

Have a goal – keep it simple Have a goal – keep it simple

Have Solutions & ask to provide proposalsHave Solutions & ask to provide proposals

Be Realistic! (non - expansion states Be Realistic! (non - expansion states especially) especially)

Essential Elements of a Strategy to Leverage Essential Elements of a Strategy to Leverage ACA plans for ADAP Client Transitions: ACA plans for ADAP Client Transitions:

Create a workgroup of PLWH, service Create a workgroup of PLWH, service providers, and opinion leaders:providers, and opinion leaders:– Within the statewide planning group if you Within the statewide planning group if you

have one, or start a task force: locally, then have one, or start a task force: locally, then get regional participation, then statewide get regional participation, then statewide (include various stakeholders) (include various stakeholders)

– Work with the available data from the Health Work with the available data from the Health Department, and calculate the overall costs Department, and calculate the overall costs of providing medications, versus the average of providing medications, versus the average cost of the Marketplace plans in your area! cost of the Marketplace plans in your area!

Essential Elements of a Strategy to Leverage Essential Elements of a Strategy to Leverage

ACA plans for ADAP Client Transitions: ACA plans for ADAP Client Transitions: Develop a timelineDevelop a timeline

– Work backwards from dates you need to Work backwards from dates you need to start enrollment (November 15start enrollment (November 15thth 2014) 2014)

– Key events for calculating operational issues; Key events for calculating operational issues; average costs per premiums, up front average costs per premiums, up front deductible costs, formulary management deductible costs, formulary management issues, contrast HIV provider networks, etc…issues, contrast HIV provider networks, etc…

– Link tasks to an accountable person or Link tasks to an accountable person or groups or agencies to keep things organized! groups or agencies to keep things organized!

Essential Elements of a Strategy to Leverage Essential Elements of a Strategy to Leverage ACA plans for ADAP Client Transitions: ACA plans for ADAP Client Transitions:

Working without a Crystal Ball: The Working without a Crystal Ball: The variables are critical, but unknown variables are critical, but unknown – Part B Grant Award for the upcoming yearPart B Grant Award for the upcoming year

– Find the actual plans available for each Find the actual plans available for each area included in the transitionarea included in the transition

– Some will have robust formularies, some Some will have robust formularies, some won’t; provider coverage can change won’t; provider coverage can change drastically drastically

– Costs for medications, premium increases Costs for medications, premium increases etc…etc…

Essential Elements of a Strategy to Leverage Essential Elements of a Strategy to Leverage ACA plans for ADAP Client Transitions: ACA plans for ADAP Client Transitions:

Have solutions! Have solutions! – Identify areas where you can reduce costs, Identify areas where you can reduce costs,

provide better efficiencies, or areas to improve provide better efficiencies, or areas to improve productivity (PBM requirements, detailed productivity (PBM requirements, detailed analysis of plans beyond formularies etc…) analysis of plans beyond formularies etc…)

– Identify all of the existing resources to leverage Identify all of the existing resources to leverage ACA Marketplace enrollers & staff ACA Marketplace enrollers & staff

– Sometimes your suggestions are working Sometimes your suggestions are working against the Bureaucracy’s goals – be willing to against the Bureaucracy’s goals – be willing to compromise in some areas (open plans, open compromise in some areas (open plans, open formularies, simple payment processes can be formularies, simple payment processes can be unrealistic for brittle DOHs) unrealistic for brittle DOHs)

Essential Elements of a Strategy to Leverage Essential Elements of a Strategy to Leverage ACA plans for ADAP Client Transitions: ACA plans for ADAP Client Transitions:

The parameters, both good and bad! The parameters, both good and bad! – Costs per client per month for medications Costs per client per month for medications

– DeductiblesDeductibles

– Monthly PremiumsMonthly Premiums

– Co Pays Co Pays

– Federal Subsidy Amounts Federal Subsidy Amounts

– Formulary Limitations Formulary Limitations

– Network’s HIV Provider inclusion - Timing LagNetwork’s HIV Provider inclusion - Timing Lag

– Appeals – dealing with Private Ins. IndustryAppeals – dealing with Private Ins. Industry

Florida Overview – Florida Overview – CascadeCascade

Florida Overview – Trends in Florida Overview – Trends in Care: Viral Load SuppressionCare: Viral Load Suppression

ADAP AttachmentsADAP Attachments

ADAP AttachmentsADAP Attachments

Opportunity StatementOpportunity Statement Currently the Fl. Dept. of Health can serve approx. Currently the Fl. Dept. of Health can serve approx.

14,500 persons on ADAP with level funding. 14,500 persons on ADAP with level funding.

A pilot project for 500 people NOW will provide actual A pilot project for 500 people NOW will provide actual utilization & cost data this cycle, aiding in more utilization & cost data this cycle, aiding in more accurate projections for the upcoming enrollment accurate projections for the upcoming enrollment period (Nov 14)period (Nov 14)

For next enrollment cycle, we proposed a unique For next enrollment cycle, we proposed a unique project transitioning 5,102 clients from ADAP to the project transitioning 5,102 clients from ADAP to the ACA Marketplace & involves other local Ryan White ACA Marketplace & involves other local Ryan White Grantees to help ensure program stability (See Grantees to help ensure program stability (See diagram) diagram)

Various workgroups assist in solutions for a variety of Various workgroups assist in solutions for a variety of operational & policy issues as well as refining operational & policy issues as well as refining financial projections on a regular basis financial projections on a regular basis

Potential Effects - ADAPPotential Effects - ADAP

Expected Savings to the Expected Savings to the program- ADAPprogram- ADAP

Funding based on an average of $10,000 per client per year. Funding based on an average of $10,000 per client per year.

Projected avg. cost of $560 per premium & $3,537 per annual deductibleProjected avg. cost of $560 per premium & $3,537 per annual deductible

ADAP Federal Poverty Level ADAP Federal Poverty Level NumbersNumbers

FPL Aprox. Number Potential Savings to ADAP

0 – 99% 8089 No impact

100 – 249% 5102 Approx. 12 Million

250 – 400% 992 Approx 9.4 Million

Expected Savings to the Expected Savings to the program- ADAPprogram- ADAP

Newly available slots

Potential cost savings

1,500 $12 Million

Anticipated Benefits of Transition

Workgroup Analysis- Workgroup Analysis- ADAPADAP

Expected Savings to ADAPExpected Savings to ADAP

ADAP AttachmentsADAP Attachments

ADAP ADAP AttachmentsAttachments