Improving the quality and cost-effectiveness of publicly financed health care
Presentations from the Medicaid Purchasing Leadership Summit
In March 2008, CHCS hosted the Medicaid Purchasing Leadership Summit and brought together leaders from 15 state Medicaid agencies, health plans, and select Medicaid policy experts to discuss best practices to improve health outcomes and control health care spending. The participating states and health plans were already working with CHCS to develop practical solutions to better manage the care of people with disabilities, align financing with quality, and use forecasting tools to identify returns on investment for quality improvement initiatives.
Presentations from the two-day event are below.
Keynote: Reality Check - Medicaid Budgets in 2008 and Beyond
Keith Fontenot, Deputy Assistant Director of Health and Human Resources at the Congressional Budget Office, put state Medicaid budgets into the national context and addressed how efforts to improve quality - especially for patients with chronic illnesses - could bend unsustainable cost trends for publicly financed programs.
Session 1: The Faces of Medicaid - Addressing the Needs of People with Comorbidities
Understanding disease prevalence and patterns of this heterogeneous group can help states and health plans tailor programs more appropriately. Presenters provided a "portrait" of Medicaid beneficiaries with comorbidities and shed light on how to rethink care management approaches.
- Cynthia Boyd, Johns Hopkins University (PDF)
- Rick Kronick, University of California, San Diego (PDF)
Session 2: Lessons from the Medicaid Value Program
The Medicaid Value Program brought together 10 multi-stakeholder teams to test innovative care delivery models for Medicaid beneficiaries with multiple chronic conditions. Two of the teams and Mathematica Policy Research, the program's evaluator, shared promising lessons for improving care for beneficiaries with comorbidities.
- Marsha Gold, Mathematica Policy Research (PDF)
- Alice Lind, Washington State Department of Health and Social Services
- Peter Fagan, Johns Hopkins Healthcare, LLC (PDF)
Session 3: Innovations in Pay-for-Performance - Improving Quality at the Point of Care
Through the Pay-for-Performance Purchasing Institute, states designed and/or implemented physician-level incentive programs. Two states described their pay-for-performance programs and the methods they used to determine the appropriate incentive payment for providers.
- Marc Leib, Arizona Health Care Cost Containment System (PDF)
- George Oestreich, Missouri Department of Social Services (PDF)
Session 4: Innovations in Managed Care Programs for People with Disabilities
Through the Managed Care for People with Disabilities Purchasing Institute, states developed strategies to enhance or expand programs for the SSI-eligible population. Representatives from two states -- Indiana and Washington -- discussed experiences in designing and implementing new care management approaches for adults with disabilities.
- Submission from Indiana Family and Social Services Administration (PDF)
- MaryAnne Lindeblad, Washington State's Health and Recovery Services Administration, Department of Social and Health Services (PDF)
Session 5: Innovations in Return on Investment (ROI) Tools and Techniques
Through the Return on Investment Purchasing Institute, states developed the capacity to forecast potential financial returns generated by investments in quality improvement. Two of the participating states described how they are using the ROI Forecasting Calculator to estimate ROI, develop quality initiatives, and support budget requests.
- Lise DeShea, Oklahoma Health Care Authority (PDF)
- Lesley Abram, Colorado Department of Health Care Policy and Financing (PDF)
Sessions 6 and 8: Affinity Group Presentations
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Exploring Public-Private Payer Collaboration in Pay-for-Performance Programs (PDF)
Two leaders from the Minnesota's Buyers' Health Care Action Group - one representing Medicaid and one representing the commercial sector - shared their experience collaborating in Minnesota's Bridges-to-Excellence (BTE) program.
- Purchasing Health Care for Chronic Populations (PDF)
A presentation from Dr. Peter Fagan of Johns Hopkins HealthCare identifies the strategies used to coordinate substance abuse treatment with disease management and care management programs.
Session 7: Working with Philanthropy to Create Regional and State Quality Improvement and High Performance Health Systems
Leaders from two major philanthropic organizations addressed how states can strive to become high performance health systems. Speakers discussed outcomes from national quality improvement initiatives and how those lessons can be applied to state purchasing decisions.
Session 9: As Tough Times Ebb and Flow -- National and State Perspectives on Medicaid Financing and Quality
In the beginning of state fiscal year 2008, Medicaid programs were experiencing fewer budget pressures, allowing them to place a higher priority on improving health care quality. However, the economic climate began to change in fall 2007. This presentation offers a national view of how Medicaid programs are responding to these fiscal constraints.