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CEO, Amerigroup New YorkAchieving Value for States with CoordinatedLong-Term Care Solutions

Bob Wychulis

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Overview

• About Amerigroup• New York Medicaid Redesign Solutions• State Models of Managed Long-Term Care (MLTC)• Medicaid Health Plans and MLTC

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Who We Are: Amerigroup

• We coordinate health care services for 2 million members in 11 states, including New York

• We meet the health care needs of financially vulnerable Americans, seniors and people with disabilities

• We serve those on Medicaid, Medicare and other publicly funded health care programs

• We build strong community relationships andalliances to support our local health plans

• We offer 15 years experience dedicated togovernment programs

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As a Medicaid managed care organization we:1.Increase access to careManaged care increases access to primary care and the use ofpreventive services while lowering costs

2.Yield cost savingsBy collaborating with doctors, hospitals and other providers to ensure beneficiaries receive proactive health services and supports, managedcare reduces the incidence of acute episodes of care, improves thequality of life and reduces overall burden on the taxpayers

3.Achieve quality improvementsManaged care achieves quality improvements by adhering to quality standards and monitoring procedures. No comparable standards or procedures are required in Fee-For-Service arrangements

Benefits of Medicaid Public-Private Partnerships

• Amerigroup New York serves 109,000members in the Medicaid, Children’s HealthInsurance Program (CHIP), MLTC andMedicare Advantage programs

• Serves members in Putnam Countyand the five boroughs of New York City

• We employ 380 associates, including 49doctors, nurses and social workers

• Network includes 16,375 providers and 48 hospitals• Fully integrated long-term care plan offering

for dually eligible individuals

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Amerigroup in New York

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• Focus of New York Medicaid Redesign Team (MRT):o New York’s Medicaid program is unsustainableo Need to build on managed care’s significant quality gainso Goal: Develop a reform package that saves money and improves qualityo Identify major savings opportunities, including managed long-term care

• New York Medicaid status quo:o 66 percent of recipients enrolled in a managed care model at a total

cost of $17 billion; 27 percent are excluded from managed care at nearly double the cost – $29 billion

o 11 percent of long-term care recipients are enrolled in MLTC,at a cost of slightly more than $1 billion

o 89 percent receive LTC through an alternative model of care or aninstitution, at a total cost of more than $11 billion

Looking Forward: Medicaid Redesign in New York

Source: State of New York Department of Health, New York Medicaid Redesign Team, “Building a more affordable, cost-effective Medicaid program” (Jan. 13, 2011)

865,000 New York Medicaid Patients with Multiple Chronic Illness Intellectual or Development Disability

50,000 recipients$6 billion/$10,500 Per Member,Per Month (PMPM)Issue: Rapidly growing expense

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State of Spending: High-Cost Patients

Long-Term Care

200,000 recipients$11 billion/$4,500 PMPMIssue: High cost – lack of services management and coordination

Behavioral Health

300,000 recipients$5 billion/$1,400 PMPMIssue: High cost – lack of services management and coordination

Chronic Medical

300,000 recipients$21 billion/$695 PMPMIssue: High cost – lack of services management and coordination

Source: State of New York Department of Health, New York Medicaid Redesign Team, “Building a more affordable, cost-effective Medicaid program” (Jan. 13, 2011)

New Solutions forLong-Term Care:

• ManagedLong-Term Care

• Consumer Directed Models

• Integration of Medicaid and Medicare

New York MRT Recommends Focused Approach to Long-Term Care

Percent Change Per Recipient of Long-Term Care Spending, 2003–2009(in New York, by Program, Six-Year Average)

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MLTC Nursing Adult Long-Term Personal Certified Home Homes Day Home Care Health Care Care Health Care Agencies

Source: State of New York Department of Health, New York Medicaid Redesign Team, “Working together to build a more affordable, cost-effective Medicaid program: (Feb. 9, 2011)

Tennessee and New Mexico: Other Successful MLTC Models

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TennCare CHOICES inLong-Term Care Program• 4,000 face-to-face assessments completed within first six months• Lowered nursing facility rate from 81 to 71 percent of membership

• 41 members transitioned from a nursing facility to a community-based setting, saving the State more than $1 million• Raised share of members in the community• 1,013 new services identified as “gaps in service” for members in home-based care

Coordination of Long-Term Services (CoLTS) Program• 16,282 members enrolled into disease management programs • Cost of serving the CoLTS population in 2011 projected to save $25 million

• 207 members reintegrated from nursing facilities to the community • 2,345 healthy dual-eligible members at imminent risk of nursing facility placement have been kept out of nursing facilities

Other models of managed long-term care help states increase quality of care while lowering costs

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Developing Long-Term Care That Advocates Community Living• New York Managed Long-Term Care (MLTC) program

enables members to maintain independence while receiving the care they need

• Key program components include: o Applying a system of assessment, care planning and service coordination

in order to restore or retain an individual’s level of function o Key services include: nursing services in the home, therapies in the

home, home health aide services, personal care services in the home,adult day health care, social day care

• By ensuring the right mix of services and supports, theAmerigroup program is able to:o Push-out the point at which an individual enters a nursing facility, oro Eliminate the need for institutionalization

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• Provides a one-source contact to help seniors and people with disabilities navigate the health care system

• Transitions residents from institutional settings totheir preferred setting: at home or in the community

• Coordinates a system of care to identify additional service needs that prevent avoidable acute conditions

• Offers caregivers and family members helpsupporting their loved ones

• By preventing and avoiding institutionalization, improves member independence and quality of life

Value of Managed Long-Term Care

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• Amerigroup interventions improve thequality of life for New York MLTC recipients

• About an Amerigroup member – “Rosa”o Diagnosed with degenerative scoliosiso Received Medicaid, Medicare Part D and a health plan

benefits but was not receiving adequate care

• Through Amerigroup, “Rosa” receivedsupportive counseling and an assessment of her home environment and her functional statuso She is able to keep her current home health aide, who was employed

by a nonparticipating vendoro With Amerigroup, she is able to remain at home and maintain her

independence

Real Stories, Real Results: “Rosa”

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Real Stories, Real Results: “Sarah”

• Amerigroup efforts enhance availability of services for New York MLTC recipients and their families

• About an Amerigroup member – “Sarah”o Bedridden, diagnosed with aphasia and had limited mobilityo Relied on her daughter for daily care and other services

• Through Amerigroup, “Sarah” gains accessto new equipment enhancing her quality oflife and lessening the likelihood of hospitalizationo She is able to access a proper hospital bed, pressure-reducing mattress and

geriatric wheelchair to keep her healthyo With Amerigroup, she and her family accessed the services and equipment

necessary to ensure Sarah remains at home with her family

Bob WychulisChief Executive Officer

Amerigroup Community Care of New York360 West 31st Street, Fifth Floor

New York, NY 10001(212) 372-6902

rwychul@amerigroupcorp.comwww.amerigroupcorp.com

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Thank You