Virginia Health System Perspective on CCC Program

Virginia Health System
Perspective on CCC Program
House Appropriations HHR
January 27, 2015
Virginia Health System Perspective on CCC Program
• Health systems are committed to helping make the CCC /dual
eligible program a success for all
• Regional and market variation in plan-provider participation
and shared risk arrangements is a positive
• Challenges with enrollment and opt-outs are multi-faceted,
health systems will continue to work with our DMAS and plan
colleagues to address all factors
Virginia Health System Perspective on CCC Program
Committed to Success of CCC / Dual-eligible Program
• VHHA has been a strong supporter of the dual-eligible program
 Since 2010 when our actuarial analysis found that improving care for
this population would yield significant savings
 DMAS leadership has been championing it even longer
• Dual-eligible recipients are among the patients with the most
significant and complex health care needs
 Hospitals are at risk via Medicare readmission penalties for
improving care coordination
• Improving care quality and value requires very close front-line
provider coordination over time and across settings
• It also requires a different way of doing business between atrisk plans and health systems
Virginia Health System Perspective on CCC Program
Regional and Market Variation
• An environment in which every provider/system participates
with every plan is not the best path for long term success
• Regional and market variation on plan-provider integration
models is helpful for determining what works best
• Successful models will likely vary region to region
• It is innovation at the front-line – where providers treat and
counsel patients – where the real value improvement exists
• Helping patients choose the right plan-provider combination to
meet their needs is the objective we all share
Virginia Health System Perspective on CCC Program
Enrollment and Opt-out Issues are Complex
• CCC program is still in the early stages of implementation
• Plan-health system relationships have and will evolve
• Many factors for slower enrollment and high opt-out rates
Incomplete Medicare information that has yielded “un-intelligent”
automatic assignments is at least part of the problem
DMAS efforts at provider and recipient outreach have been excellent
This effort must continue and health systems are willing to help
• We are committed to working with our DMAS and plan
colleagues to addressing all the enrollment impediments and
ensure recipients choose and stay with the system that best
fits their needs
Thank You
• Hospitals and health systems look forward to working with all
of you to address the challenges and accelerate the good
reforms underway
• We are proud to provide high quality, compassionate care to
all Virginians and committed to helping make Virginia the
healthiest state in the nation
• Thank you for your service to the Commonwealth