PowerPoint Presentation...2016/01/19 · Coventry Humana Molina United Sunshine 6.2 4.9 4.4 3.7 3.3...
Transcript of PowerPoint Presentation...2016/01/19 · Coventry Humana Molina United Sunshine 6.2 4.9 4.4 3.7 3.3...
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Sunshine 38%
United 24% American
Eldercare 16%
Molina 6%
Amerigroup 6% Coventry
5%
Humana 5%
September 2014 LTC Plan Enrollment
Staywell 24%
Sunshine 15%
Amerigroup 12%
Prestige 11% Humana
10%
United 9%
Molina 3%
Better Health 3%
Integral 3%
Simply 3%
First Coast Advantage
2%
Coventry 2%
SFCCN 2%
Preferred 1%
September 2014 MMA
Standard Plan Enrollment
Children's Medical Services
45%
Magellan 32%
Sunshine 16%
Clear Health
6%
Positive Healthcare
1%
September 2014 MMA
Specialty Plan Enrollment
Source: Florida Medicaid Management Information
System (FLMMIS) Eligibility Information, Enrollment and
demographic information, August 2013 - September
2014.
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0
500
1,000
1,500
2,000
2,500
3,000
3,500
18 28 38 48 58 68 78 88 98 108
Age 85 and Older
Age 65 - 84
Age Under 65
LTC Enrollees by Age, September 2014
0
20
40
60
80
100
120
140
0 10 20 30 40 50 60 70 80 90 100 110
Tho
usa
nd
s
Age
Ages Under 14
Ages 14 - 20
Ages 21 and Older
MMA Enrollees by Age, September 2014
0
1,000
2,000
3,000
4,000
5,000
6,000
0 10 20 30 40 50 60 70 80 90Age
Age 21 and Older
Age 6-20
Age Under 6 Years
Specialty Plan Enrollees by Age, September 2014
Source: Florida Medicaid
Management Information System
(FLMMIS) Eligibility Information,
Enrollment and demographic
information, September 2014.
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SMMC Capitation Payments
LTC Plans
MMA Standard
Plans
MMA Specialty
Plans
Payment Date Range 8/2013 – 6/2014 5/2014 – 6/2014 5/2014 – 6/2014
Total Capitation Payments $1,578,380,771 $482,392,603 $15,070,533
Average Payment Per Member Per Month $3,284.92* $267.90 $796.33*
Source: Florida Medicaid Management Information System (FLMMIS), Information about capitation payments to plans, August 2013
- June 2014.
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0
2
4
6
8
10
12
14
16
Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14
Nu
mb
er o
f C
om
pla
ints
Per
1,0
00
Enro
llees
Source: Complaint Issues Reporting and Tracking System (CIRTS), Information about complaints registered with the
Agency, August 2013 - August 2014.
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2,666,845 2,722,161 2,756,632 2,776,111 2,814,327 2,864,544 2,911,516 2,954,920 2,967,917
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15
Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, August 2014 – April 2015
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0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15
Staywell
Sunshine
Amerigroup
Prestige
Humana
United
Molina
Better Health
Integral
Simply
CMS Network
Coventry
SFCCN
Magellan
First Coast
Preferred
Sunshine Specialty
Clear Health
Positive Healthcare
Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, August 2014 – April 2015
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Received No Services
Received at Least One Service
Source: Florida Medicaid Managed Information System (FLMMIS) Encounter Claims Data,
August 2014 – December 2014
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0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15
Number MMA Standard Plan Issues Per 1,000 Enrollees
Number MMA Specialty Plan Issues Per 1,000 Enrollees
Source: Complaints Issues Reporting and Tracking System (CIRTS), August 2014 – April 2015
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83,509 83,626 83,639 83,276 83,597 83,605 83,802 84,497 85,154 85,516 85,733 85,651 86,310 86,705
0
20,000
40,000
60,000
80,000
100,000
Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15
Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, March 2014 – April 2015
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0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
Sunshine
United
American ElderCare
Molina
Amerigroup
Coventry
Humana
Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, March 2014 – April 2015
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Received No Services
Received at least One Service
Source: Florida Medicaid Managed Information System (FLMMIS) Encounter Claims Data, March 2014 – December 2014
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Source: Plan Submitted Enrollee Residence Report, March 2014 – July 2015, and Florida Medicaid Managed
Information System (FLMMIS) Eligibility Information, March 2014 – July 2015.
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0%
25%
50%
75%
100%
Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15
47.2%
47.6%
47.2%
47.7%
48.4%
49.2%
55.6%
50.6%
50.1%
50.1%
49.9%
50.7%
50.3%
52.8%
52.4%
52.8%
52.3%
51.6%
50.8%
44.4%
49.4%
49.9%
49.9%
50.1%
49.3%
49.7%
Community Setting Institutional Setting
Source: Plan Submitted Enrollee Residence Report, March 2014 – July 2015, and Florida Medicaid Managed
Information System (FLMMIS) Eligibility Information, March 2014 – July 2015.
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75.4%
58.5% 57.7% 57.6% 53.6% 49.2% 42.6% 42.5%
24.6%
41.5% 42.3% 42.4% 46.4% 50.8% 57.4% 57.5%
0%
25%
50%
75%
100%
Amerigroup Molina AmericanEldercare
Humana Coventry All Plans United Sunshine
Community Setting Institutional Setting
Source: Plan Submitted Enrollee Residence Report, March 2014 – July 2015, and Florida Medicaid Managed Information System
(FLMMIS) Eligibility Information, March 2014 – July 2015.
*Humana enrollees are included with American ElderCare from July 2015 forward. Beginning July 2015, Humana began
operating its LTC plan as Humana American Eldercare.
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61.9%
34.4% 25.9% 19.6% 19.3% 13.5%
0%
25%
50%
75%
100%
Sunshine United Amerigroup HumanaAmericanEldercare
Molina Coventry
Comprehensive Not Comprehensive
*Humana enrollees are included with American ElderCare from July 2015 forward. Beginning July 2015, Humana began
operating its LTC plan as Humana American Eldercare.
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0%
2%
4%
Percentage ofCommunity Enrolleeswho Transferred to a
Nursing Facility
Percentage of NursingFacility Enrollees who
Transferred to theCommunity
1.6%
2.9%
0
2
4
6
8
Amerigroup AmericanEldercare
Coventry Humana Molina United Sunshine
6.2
4.9 4.4
3.7 3.3
2.6
2.0
Source: Plan Submitted Enrollee Residence Report, June 2014
– July 2015, Plan Submitted Nursing Home Transfer Report,
March 2014 – May 2014, and Florida Medicaid Managed
Information System (FLMMIS) Eligibility Information, March
2014 – July 2015.
Percentage of Nursing Facility Enrollees Who Transferred to the Community
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617 701
799 884
950 992
1,117 1,223
1,331 1,410
1,472 1,552
1,629 1,689
1,791 1,897
1,956
0
500
1,000
1,500
2,000
Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15
PDO Enrollees
Source: Plan Submitted PDO Report, March 2014 – July 2015, and Florida Medicaid Managed Information
System (FLMMIS) Eligibility Information, March 2014 – July 2015.
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56.8%
62.4%
54.4%
45.6%
44.2%
47.0%
45.4%
27.9%
39.9%
44.2%
48.7%
51.3%
52.5%
57.1%
58.4%
74.9%
-80% -60% -40% -20% 0% 20% 40% 60% 80%
United
Sunshine
Across All Plans
Coventry
Humana
American Eldercare
Molina
Amerigroup
% Enrollees Receiving Institutional Services
% Enrollees Receiving Community Services
*Some services can be received in either an institutional or community setting and are not included in this graph. Therefore, institutional and community
percentages will not total to 100 percent of enrollees.
Source: Florida Medicaid Managed Information System (FLMMIS) Encounter Data, March 2014 – February 2015, and FLMMIS FFS Claims Data for
American ElderCare, March 2014 – August 2014.
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0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
Mill
ion
s
Continued in FFS
Entered or LeftMedicaid
Changed within theMedicaid Program
Continued in MMA
Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, May 2014 – October 2015.
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0
100,000
200,000
300,000
400,000
500,000
600,000
Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15
Died Left Medicaid Entered Medicaid
Moved between FFS and MMA Changed MMA Plans Plan Mergers and Acquisitions
Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, May 2014 – October 2015.
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-30,000
-20,000
-10,000
0
10,000
20,000
30,000
Net Gain to Standard Plan Net Gain to Specialty Plan
Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, May 2014 – October 2015.
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0
25,000
50,000
75,000
100,000
Continued in PACE
Continued in FFS
Plan Acquistion, Changed LTC Plan, or Moved between LTC and FFS or PACE
New to or No Longer Receiving LTC Services
Continued in LTC
Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, August 2013 – October 2015.
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0
2,500
5,000
7,500
10,000
Died No Longer Receiving LTC Services
New to LTC Services Moved between LTC and FFS or PACE
Changed LTC Plan Plan Mergers and Acquisitions
Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, August 2013 – October 2015.
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-1,000
-500
0
500
1,000
1,500
2,000
Sunshine Coventry Amerigroup Humana Molina United AmericanElderCare
Source: Florida Medicaid Managed Information System (FLMMIS) Eligibility Information, August 2013 – October 2015.
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$0
$200,000,000
$400,000,000
$600,000,000
$800,000,000
$1,000,000,000
$1,200,000,000
Total Revenue
Source: Annual Achieved Savings Rebate Financial Report, May 1, 2014 – December 31, 2014
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0%
20%
40%
60%
80%
100%
120%
140%
Amount Paid for MMA Services as a Percentage of Revenue
Source: Annual Achieved Savings Rebate Financial Report, May 1, 2014 – December 31, 2014
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-50%
-40%
-30%
-20%
-10%
0%
10%
Cle
ar H
ealt
h A
llian
ce
Sim
ply
SFC
CN
Bet
ter
Hea
lth
Stay
wel
l
Inte
gral
Am
erig
rou
p
Po
siti
ve
Tota
l
Pre
stig
e
Ma
gella
n
Firs
t C
oas
t A
dva
nta
ge
Co
ven
try
Sun
shin
e
Mo
lina
Hu
man
a
Un
ited
Pre
ferr
ed
Operating Margin
Source: Annual Achieved Savings Rebate Financial Report, May 1, 2014 – December 31, 2014
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0%10%20%30%40%50%60%70%80%90%
100%
Percentage of Plan Revenue Spent on Hospital Services
Source: Annual Achieved Savings Rebate Financial Report, May 1, 2014 – December 31, 2014
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0%
20%
40%
60%
80%
100%
120%
140%Other State Plan
Transplant
Transportation
Dental
Mental Health & SubstanceAbuse
Pharmacy
Professional
Hospital
Source: Annual Achieved Savings Rebate Financial Report, May 1, 2014 – December 31, 2014
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-
200,000,000
400,000,000
600,000,000
800,000,000
1,000,000,000
1,200,000,000
1,400,000,000
Sunshine United AmericanEldercare
Molina Coventry Humana Amerigroup
Total Revenue
Source: Annual Achieved Savings Rebate Financial Report, January 1, 2014 – December 31, 2014
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0%
20%
40%
60%
80%
100%
Sunshine Coventry United Total Humana Molina AmericanEldercare
Amerigroup
Percentage of Revenue Spent on LTC Services
Source: Annual Achieved Savings Rebate Financial Report, January 1, 2014 – December 31, 2014
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-14.00%
-12.00%
-10.00%
-8.00%
-6.00%
-4.00%
-2.00%
0.00%
2.00%
4.00%
6.00%
Am
eri
gro
up
Mo
lina
Hu
man
a
Tota
l
Sun
shin
e
Un
ited
Am
eric
an E
lder
care
Co
ven
try
Operating Margin
Source: Annual Achieved Savings Rebate Financial Report, January 1, 2014 – December 31, 2014
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0%
20%
40%
60%
80%
100%
120%
Sun
shin
e
Un
ited
Co
ven
try
Hu
man
a
Mo
lina
Am
eric
an E
lder
care
Am
erig
rou
p
LTC Services Settlements
Ending IBNP
Subcapitated
Other HCBS
Transportation
Therapy Services
Medical Supplies
Home Health
Assisted Living
Hospice
Nursing Facility
Source: Annual Achieved Savings Rebate Financial Report, January 1, 2014 – December 31, 2014