Enhancing Cost Avoidance Strategies in Medicaid Programs

Explore the impact of Veterans Benefits and Long-Term Care programs on reducing expenditures, leveraging third-party liabilities, and maximizing premium savings through managed care. Key data points include cost avoidance per client, interstate matches, and premium savings across multiple matches. The program aims to optimize cost efficiency and enhance program participation critical data.

• Cost Avoidance
• Veterans Benefits
• Long-Term Care
• Managed Care
• Premium Savings

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1. PARIS & Measuring Cost Avoidance Tim Dahlin Program Manager Medicaid Program Integrity 02/24/2020

2. Veterans Benefit / PARIS Programs Long-Term Care expenditures Veterans Benefit awards (VA file) ALTSA/HCS sister agency Fee-for-Service claims Third Party Liability impact (VA, Federal files) Managed Care premiums Terminations for nonresidency (Interstate) 2

3. Long-Term Care Veterans, Survivor monetary awards (VA file) Greatest impact in LTC programs Two-year study of reduction in LTC expenditures after VA monetary award Average cost-avoidance per client, per month Enhancement start date, program participation critical data 3

4. Fee-for-Service Third-Party Liability identification TRICARE, CHAMPVA PARIS Veterans and Federal matches Diminishing impact in FFS claims TPL cost-avoidance calculation TPL source code Insurance Coverage start/end Duplicate claims scrubbed 4

5. Managed Care Premiums PARIS Interstate Match referrals Filter with: Program Start dates Claim & Encounter Residency Attestation not provided Termination Reason Code 5

6. Managed Care Premiums (cont.) Critical Data Termination Date Managed Care Enrollment End Date Managed Care Premium Rate (final month) Certification End Date 6

7. MC Premium Savings Single Interstate Match 201708 $150,000 $100,000 $50,000 $0 7

8. MC Premium Savings Multiple Interstate Matches 201708 - 201902 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 $0 Dec-17 Dec-18 Feb-18 Feb-19 Jun-19 Jan-18 Mar-18 Jul-18 Jan-19 Mar-19 Jul-19 Sep-18 Sep-19 Jun-18 Apr-18 Aug-18 Apr-19 Aug-19 Nov-17 May-18 Oct-18 Nov-18 May-19 201708 201711 201802 201805 201808 201811 201902 8

9. MC Premium Savings Multiple Interstate Matches - Stacked 201708 - 201902 $2,200,000 $2,000,000 $1,800,000 $1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 $0 Dec-17 Dec-18 Feb-18 Feb-19 Jun-19 Jan-18 Mar-18 Jul-18 Jan-19 Mar-19 Jul-19 Sep-18 Sep-19 Jun-18 Apr-18 Aug-18 Apr-19 Aug-19 Nov-17 May-18 Oct-18 Nov-18 May-19 201708 201711 201802 201805 201808 201811 201902 9

10. Questions? More Information: Tim Dahlin Program Manager, PARIS and Veterans Benefit programs Medicaid Program Integrity tim.dahlin@hca.wa.gov Tel: 360-725-2077 10