Medicaid Modernization Farmington Public Input Working Sessions July 12, 2011 Table Group Comments Table 1 Coordinated

d Service Delivery System 1. The State is considering making all its health plans provide a full package of services from prevention through home and community based through nursing facility in one system. What things would you want to make sure health plans do to support the elderly and physically disabled in such a system? 2. (if time allows) As the State looks towards creating a coordinated service delivery system, what are the top 2 things you want us to pay attention to? Avoiding disruption of care PCO - get to be boss (self directed) Continue to have Public Forum Keep services to help people be more independent Value to keep people at home Nursing Home can be restrictive dont get to do as much Keep option of keeping a loved one at home rather than go to nursing home Dont want Medicaid to cut hours for PCO People with TBI need more hours Concern that there are young people (over 18) who are perfectly able to get a job. Should have medical documentation to be covered Concerned there are a lot of unnecessary services Want to keep in rural areas in mind when creating services Generational and cultural differences

Table 2 Personal Responsibility 1. How do you think the State could increase the sense of personal responsibility that people take for their own health and for helping to financially support the services they need? 2. (if time allows) What are the top 2 things you would want the State to keep in mind as we introduce a greater sense of personal responsibility into the system? Need access to rural areas Better regulation on TANF and Food Stamps (cant buy candy or pop or cigarettes)
1|Page

Community access to health care. Do not like co-payment situation Would like to see a model of 1 waiver Wellness and prevention. Be more proactive. Make sure in the schools. Could be a sliding scale to co-pays

Table 3 - Pay for Performance 1. In todays system, medical providers tend to get paid based on the number of services they provide whether those services make people better or not. The State would like to focus more on paying for results like helping people become healthier and stay healthy. What are some ideas you have for how we can achieve this goal? 2. (if time allows) What are the top 2 items you would want the State to keep in mind to help us pay for value and health outcomes instead of the number of services provided? State needs to help with providers to make sure they are doing what they are doing at home. Nursing homes arent for everybody. Politicians stop double dipping Medicaid needs to provide alternate resources, i.e. gym membership, diet food, classes. Work on getting more accepting Medicaid providers access. Look more at prevention programs Providers provide more pro-bono services or volunteer services More reimbursement to providers to keep them in the service area One electronic health record system Have all service fees the same across the board for all providers Pay for performance evidence based practices

Table 4 Coordinated Service Delivery System 1. What do you think is the best way for the State to provide services to people with a developmental disability? Right now, a small number of people get a lot of services and others get fewer or no services. How can we make this system fair for all given that we have limited resources? 2. (if time allows) As the State looks towards creating a coordinated service delivery system, what are the top 2 things you want us to pay attention to? Provide home and community based services that are cheaper and have them available Have services based on peoples needs
2|Page

Money follows the person Reframe the questions asked to have them look more at how people can get services rather than cut services Get people off waiting lists Get services that people want, not just what they have to have to be on the waiver Have waiver reflect what people need Higher co-pays. Fear that higher co-pays people wont get services and lead them into the ER Dont cut attendant care hours. This leads to other things that cost more example: hours cut and suffered injury while attendant wasnt there. Reward patient and providers for getting and giving preventative care, rather than charging co-payments for services. Would be a true partnership between patient and provider. Keep the behavioral health services separate. Need for services to be provided locally. Access Be one general waiver for behavioral health rather than the separate ones. Concern about waivers in general. Global waiver would be beneficial if to save administrative costs. Dont use to cut services to waive individual access and rights. Use to protect access and rights and use to cut down on admin. Costs. What is a healthy outcome for BH? May not be as clear cut in medical care. Long-term care 30 day requirement to get the waiver from a longterm care facility to home. Instead waive these requirements so people can get out when they want to get out. Cost savings will justify. Coordinated care system There should be access to consistent services, especially in rural and local areas. Be adequate payment to health care provides so they will accept Medicaid. Look at definition of provider and see if you can adjust to be more culturally sensitive so families can provide certain care. If consolidate services that there be a choice among providers for people to pick the best for them. Other issues Housing. If where you live is not safe will affect the cost of medical care. What is a medical home? What is the concept whether it is a good thing or not.
3|Page

Transportation bus hours end too early and no weekend service. Getting to provider is difficult.

Table 5 Personal Responsibility 1. What could the State do to help make sure people do not go to the Emergency Room unless they have a real medical emergency? 2. (if time allows) What are the top 2 things you would want the State to keep in mind as we introduce a greater sense of personal responsibility into the system?

Ensure all people have access to quality health care Ensure better public transportation Recommendation for nurse and medical hotline Emergency preparation readiness Free preventative care Extended hours for urgent care centers Child care assistance Expanding network of providers that accept Medicaid. Urgent care/ER model like UNMH Co-payments. Giving co-payment if urgent care is open Education campaign on health services Top 2 Keep in mind that we live in one of the poorer states in the nation. Rural and lack of services Travel time and financial resources to get to appointments Keep contractors local versus outside to respect uniqueness Ensure more behavioral health and substance abuse providers Financial incentives gas cards and school supplies Incentives for providers who take Medicaid More transparency with waivers list for dd More health care services that combined with other services, family support, food banks, etc.

Table 6 - Pay for Performance 1. The State is interested in developing health homes. A health home is a group of doctors and other health care providers who organize to provide an array of health care benefits to help members with a particular medical condition like diabetes or heart disease. What kind of medical conditions do you think we ought to address using the health home concept?
4|Page

2. (if time allows) What are the top 2 items you would want the State to keep in mind to help us pay for value and health outcomes instead of the number of services provided?

Confusion of what a health home is How do you service rural members Have to travel to Abq. For dental Doctors not getting adequate reimbursement Simplifying paperwork Lose middle management Co-pays should shut down. People cannot afford Make healthy groceries more affordable People stop and think what it is to live on $674 a month. CoLTS program is good in theory, but in this area docs dont take and have to travel to Abq., which becomes a huge expense for Medicaid. Have more public forums. Listen to the people. Why are we trying to recreate the wheel? Why dont we look at the services/waivers that are already out there and redefine. Waiting lists. People are dying before they get on them. Are the spots re-allocated on a timely manner? Who looks at this? How many people on any of the waiting lists are accessing other services, such as PCO? If so, is that what they want to stay on and, if so, take them off the waiting list they are on. Listen to the people who are living it. What kind of medical conditions we should address medical home concept Address regionally Educational services to help Question # 2 Transportation, especially in rural areas. Lack of access to providers locally.

Table 7 Coordinated Service Delivery System 1. What long term care services and supports should the State provide to help you keep your family members at home? How much responsibility for care for your family member could you take to help keep your family member safe but also keep costs down? 2. (if time allows) As the State looks towards creating a coordinated service delivery system, what are the top 2 things you want us to pay attention to?
5|Page

Education Information available Resources that people arent aware of Giving info to clients to have access to that, i.e. Alzheimers association has funds for respite for family members. other sources of income Individualize teaching and training for a specific client or caregiver or family to take better care at home. Consumer wants to have more input into their care plan. Respite hours based on acute level Ability to bank that respite if not used one year. Roll over to the next year or get credit back at least. Mid-level provider for ER. A two-track for ER. 24-hour nurse line Supply coordination. Continuing to get supplies that they dont need. Huge waste. Local recycle deposit for the supplies. More vouchers for assisting people with rent Lack of adult day care in Farmington area. Not punishing the provider if you want them to continue to take Medicaid clients. Some providers cant afford electronic health records. Question #2 Services coordinators for MCOs have too large caseloads. State doesnt pay attention to fraud. People report, but no action. Seems state does not care. Great forum!

6|Page