Janet GrantCareSource Management Group

Executive Vice President Business Development and Regulatory Affairs

Medicaid ConferenceSeptember 24, 2008

Contracting as a Dual Eligible Special Needs Plan:

Lessons Learned from Navigating the Medicare

Program

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CareSource

Mission: Making a difference in the lives of underserved people by improving their health care

• Medicaid focused non-profit health plans

– Ohio: 625,000 Medicaid members

– Michigan: 50,000 Medicaid members

• 19 years of Medicaid managed care experience

• SNP plans launched in both states January 2008

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CareSource SNP Goals

• Extend CareSource mission • Provide a continuum of care for Medicaid

ABD members • Leverage plan Medicaid expertise; knowledge

of Medicaid population needs• Invest in infrastructure to partner with states

on highest acuity and cost populations• Vehicle for Medicare/Medicaid integration• Diversify product lines

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SNP Launch Lessons Learned

• Network, network, network…..– Time and resource commitments– Armed for provider questions/resistance

• Use of consultants to jump start, provide technical assistance

• Leadership to demonstrate priority, organizational commitment, recognition of resource requirements

• Organizational involvement, need to learn MA and think through how to operate

• Marketing, marketing, marketing…..

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Competencies Required

• Medicare regulatory requirements• Sales/marketing, enrollment• Financial/benefit bid: actuarial expertise• Risk adjustment management• Network development• Pursue state Medicaid integration

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State Challenges

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State Opportunities

• Integration to increase quality of care and consumer satisfaction

• Decrease provider administrative burden• Support rebalancing of facility based vs

community based LTC• Savings associated with delay/prevention of

facility based LTC

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State Challenges

• Knowledge of SNP and integration potential• Concern that savings accrue to Medicare• Other budget and policy priorities• Technology to support• Stakeholder resistance • Statewide SNP coverage• Statutory carve out of duals from Medicaid managed

care• Voluntary MA enrollment • Operational challenges of integration

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Tale of two states…

Ohio• CMS SNP 101• SNP Work Group• ABD seamless

enrollment• Technical assistance

– Expert consultation– Savings analysis

Michigan• Plan for capitation• ABD seamless

enrollment• Consumer education

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MI Consumer Education

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Stakeholder Involvement

• Disability advocates – Community Catalyst SNP Consumer Education

Project

• Area Agencies on Aging• Low income housing• Continuing Care Retirement Communities

(CCRCs)

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Stakeholder Shared Goals

• Right care in the right place• Least restrictive environment• Case management as central strategy• Promote medical home • Quality outcomes and customer satisfaction• Coordinated care

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Current Issues

• SNP reauthorization • State contracting requirement and impact on

service area expansion opportunities• Medicare/Medicaid integration• Identification and education of eligible dual

consumers