Slides presented at the NAMD 2014 Fall Conference, November 4, 201

Griffin, Eileen, JD

English

University of Southern Maine: Digital Commons@USM

University of Southern Maine USM Digital Commons Disability & Aging Cutler Institute for Health & Social Policy 11-4-2014 Multiple Roles of Medicaid ...and the Administrative Capacity to Support Them Eileen Griffin JD University of Southern Maine, Muskie School of Public Service Follow this and additional works at: https://digitalcommons.usm.maine.edu/aging  Part of the Medicine and Health Sciences Commons Recommended Citation Griffin, E. (2014, November 4). Multiple roles of Medicaid...And the administrative capacity to support them. Presented at the National Association of Medicaid Directors (NAMD), Arlington, VA. This Presentation is brought to you for free and open access by the Cutler Institute for Health & Social Policy at USM Digital Commons. It has been accepted for inclusion in Disability & Aging by an authorized administrator of USM Digital Commons. For more information, please contact jessica.c.hovey@maine.edu. Muskie School of  Public ServiceThe Multiple Roles of Medicaid…and the Administrative Capacity to Support Them Eileen GriffinNAMD 2014 Fall Conference,  November 4, 2014Muskie School of  Public ServiceMedicaid Program Administration2013 Report Funded by Kaiser Commission on Medicaid and the UninsuredCo-authors Trish Riley, Vikki Wachino, Robin Rudowitz Policy reviewFocus group and interviews with State Medicaid Directorshttp://kff.org/medicaid/report/managing-a-high-performing-medicaid-program/2Muskie School of  Public ServiceKey Medicaid RolesPublic ServantSteward of public dollars, protector of vulnerable populations, promoter of health, and safety net for Safety Net ProvidersPublic AgentAccountable to federal government, governor, legislature  and courtsBankerDoorway to federal dollars for other state agencies and community providers Leader & Innovator Value-based purchaser, system integrator, delivery system reformer, convenerHealth PlanBenefit design, beneficiary enrollment, provider payment, quality and performance managementMuskie School of  Public ServiceInnovation & Leadership24125 5311714610302026101940PCMH ACA Health Homes ACO Initiative Dual Eligible Initiative Any Delivery SystemInitiativesIn Place in FY 2013 New/Expanded in FY 2014 New/Expanded in 2015V.K. Smith, K. Gifford, E. Ellis, R. Rudowitz & L. Snyder, Medicaid in an Era of Health & Delivery System Reform(The Henry J. Kaiser Family Foundation and National Association of Medicaid Directors), October 2014.4Muskie School of  Public ServicePerformance & QualityUtilization ManagementFinancial ManagementSystems ChangePayment Models CollaborationStakeholder EngagementSocial Services & NeedsProgram IntegrityMedicaid PolicyBeneficiary Needs ActuarialExpertiseDelivery System CapacityLeadership Population Health MedicarePolitical SkillsAdministrativ  ProceduresBudgeting & LegislatureClinical ExpertiseCommunityIntegrationData Analytics Public AgentPublic ServantLeader & Innovator Information ManagementBankerProvider Management Beneficiary ManagementHealth InsurerSkills  Expertise5Muskie School of  Public ServiceWorkforce• Mission Driven• Attracted by Innovation OpportunitiesQuality• The Basics:  Medicaid Policy & Data Analytics• Active Purchaser:  High Level Analytic, Financial & Clinical ExpertiseGaps• Baby Boomer retirements• Competition with High-Paying Private SectorTurnover6Muskie School of  Public ServicePressuresFew if any constituencies advocate for increased investment in Medicaid administrative capacity$1 cut in state funding = $2 cut in total funding for Medicaid program administrationExpansionIncrease responsibilities without increasing funding for administrationRetrenchmentCut funding for administration without reducing responsibilities7Muskie School of  Public ServiceSet BacksMore than 10% smaller, 14.4%5-10% smaller, 23.5%Smaller, but less than 5% smaller, 20.1%The same size, 17.8%Larger, but less than 5% larger, 10.4%5-10% larger, 6.7%More than 10% larger, 4.4%58% of 298 state and local governments continue to operate with a smaller workforce than they had before the 2008 economic downturn.Center for State and Local Government Excellence, State and Local Government Workforce: 2014 Trends  (Washington, DC, May 2014).8Muskie School of  Public ServiceMedicaidCMSGovernorOther State AgenciesLegislatureCourtsProvidersAdvocatesDecision MakingMedicaid answers to multiple masters and  stakeholders Shifting directions with changes in leadership Cumbersome decision making processes9Muskie School of  Public ServiceDemandsIntegratingAnswering ToNegotiatingPlanningLeadingProblem SolvingRunning InterferenceCollaboratingOverseeingCommunicating10Muskie School of  Public ServiceT.M.Amabile & M. Khaire, “Creativity and the Role of the Leader,” Harvard Business Review, October 2008;  T.M. Amabile and J. Zhou, in S.F. Dingfelder, “Creativity on the Clock,” Monitor on Psychology, November 2003.  How to Stifle Creativity1. Take away all discretion & autonomy2. Create fragmented work schedules3. Create tight timelines and rigid processes4. Provide insufficient resources5. Focus on short-term goals6. Discourage collaboration & coordination7. Keep people happy with the status quoMuskie School of  Public ServiceMisplaced Priorities?Investment Program AdministrationProgram IntegrityStrategy Upstream Prevention Downstream InterventionWorkforce 50/50 match 90/10 matchFederal Sponsored Training Programs None Medicaid Integrity Institute12Muskie School of  Public ServiceOIG FindingsSingle State Agency Errors  $160 million (32 percent of all recommended federal refunds)   Did not follow own procedures to ensure proper claiming, did not adequately monitor risk-sharing mechanisms in MCO contracts, misinterpreted federal guidelines, issued incorrect guidance to providers, etc.Sister Agency Errors $213 million (48 percent of all recommended federal refunds)  Failed to adequately monitor, failed to recoup overpayments, insufficient controls to prevent claiming for unallowable costs, etc.OIG Findings, 10/1/12 – 9/30/13. 13Muskie School of  Public ServiceBuild In-House Capacity?Buy Outside Expertise?• Does Civil Service Code limitability to offer competitive salary?• Is there a hiring freeze?• Is it a mature program?• 50/50 match• How burdensome is the procurement process? • Can you amend the contract or do you have to go out to bid again?• Is the program still in early stages of development?• FMAP for MCO administrative costs?14Muskie School of  Public ServiceState and University PartnershipsBuild data analytic and public administration capacity, and Medicaid expertiseSupport data analytics, program design and evaluation, policy researchMap:  D.J. Heller, C. Hoffman, A.B. Bindman, “Supporting the needs of State Health Policy Makers Through University Partnerships” Journal of Health Politics, Policy and Law , March 10, 2014. 15Muskie School of  Public ServiceState and Federal Partnership?Develop accreditation standards and financial incentives for adherence?Increase match for Medicaid administrative capacity? Develop Medicaid workforce training program16Muskie School of  Public ServiceContact InformationEileen GriffinMuskie School of Public ServiceUniversity of Southern MaineP.O. Box 9300Portland, Maine 04101-9300eileeng@usm.maine.edu(207) 780-481317

Multiple Roles of Medicaid ...and the Administrative Capacity to Support Them

https://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?article=1062&amp;context=aging

Multiple Roles of Medicaid ...and the Administrative Capacity to Support Them

Abstract

Similar works

Full text

Available Versions

University of Southern Maine: Digital Commons@USM