alliance for health reform congressional briefing washington, d.c. december 12, 2011
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MassHealth Demonstration to Integrate Care for Dual Eligibles: Member Focus Groups and Stakeholder Engagement. Alliance for Health Reform Congressional Briefing Washington, D.C. December 12, 2011 Corrinne Altman Moore, M.P.A. MassHealth/Executive Office of Health and Human Services - PowerPoint PPT PresentationTRANSCRIPT
Alliance for Health Reform Congressional Briefing
Washington, D.C.
December 12, 2011
Corrinne Altman Moore, M.P.A.
MassHealth/Executive Office of Health and Human Services
Commonwealth of Massachusetts
MassHealth Demonstration to Integrate Care for Dual Eligibles: Member Focus Groups and Stakeholder Engagement
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Initiative to Integrate Care for Dual Eligible Individuals
■ One of 15 states awarded a $1M planning contract from CMS Center for Medicare and Medicaid Innovation to support the development of a design proposal for a State Demonstration to Integrate Care for Dual Eligible Individuals
■ Purpose is to identify, support and evaluate person-centered models that integrate the full range of acute, behavioral health, and long term supports and services
■ Target population: 115,000 dual eligibles ages 21-64 with full MassHealth and Medicare benefits
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■ Medicare Services: All Part A, Part B, and Part D services
■ Medicaid State Plan Services
■ Additional Behavioral Health Diversionary Services
■ Additional Community Support Services
■ Integrated Care Management
– Medical and non-medical services coordinated through multi-disciplinary care teams
– Members play an active role in care planning and decisions
Proposed Benefit Design
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■ Integrated care organization (ICO) baseline requirements:
– Foundation of person-centered medical homes, with core competencies in team-based care, care coordination
– Highly developed acute, primary care, behavioral health, and long term services and supports provider networks
– Health information technology
■ Global payment for all MassHealth and Medicare services for acute and primary care, behavioral health and community support services
■ Contracted ICOs must demonstrate experience and competencies in serving individuals with disabilities, chronic behavioral health diagnoses, and chronic medical problems
Proposed Delivery Model
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Stakeholder Involvement
■ Regular consumer-focused meetings (7 to date) since March 2010
■ Open public meetings (3 to date) in Boston and Worcester, with robust participation
■ Member focus groups (4, randomly selected)
■ Public presentation of data analysis on the profile of dual eligibles age 21-64, sponsored by MMPI
■ Outreach to disability community and advocacy groups, such as:
– Potter Place Clubhouse
– Massachusetts Advocates Standing Strong (MASS)
– Disability Advocates Advancing our Healthcare Rights (DAAHR)
– M-Power
– The Transformation Center
– Boston Health Care for the Homeless Program
■ Public facing website and email address
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Focus Groups Conducted in Summer 2011
■ Four focus groups of dual eligible members ages 21-64 convened to discuss current benefits and the idea of an integrated model
■ Rich variation in geography, urban vs. rural location, and primary language
■ Valuable perspectives and input, including positive comments about some current benefits and areas that need improvement
■ Results have been summarized and presented to stakeholders, and are being considered in our design decisions
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Focus Groups: Positive Impressions and Opportunities from Health Care Experiences
Working Well:
■ Primary and specialty care
■ Hospital services
■ Medical transportation
■ PCA Services
■ Low out-of-pocket cost
■ Range of covered services
Opportunities:
■ Dental services/ Eyeglasses
■ Mailings and materials
■ Customer service
■ Annual eligibility reviews
■ Durable Medical Equipment (DME) quality and compatibility
■ Limits on physical therapy
■ Limits on covered medications
■ Case management
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Focus Groups: Integrated Care Model
Positive Change:
■ Eliminate waste; redundancy
■ Save money on duplicative administrative costs
■ Reduce bureaucratic overlap
■ Increase information sharing between two agencies
To Make it Attractive:
■ Include current providers
■ Level cost-sharing for Rx
■ Ensure continuity of care
■ Include all current benefits
■ Make accessing services simple
■ Member control over care decisions
■ Improve dental, eyeglasses, DME, care coordination
■ Inform members about change
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Demonstration Features Developed from Focus Groups, Stakeholder Feedback
■ Benefit Design:
– Improve current benefits: Dental Services, Eyeglasses, DME
– Add key benefits: Peer supports, nutrition and wellness, community health workers
■ Enrollment Process and Outreach:
– Neutral/impartial enrollment broker
– Sufficient time and clear information to make a choice
■ Provider Networks:
– Preserve connections to current providers and caregivers
– Require entities to continually enroll providers that meet network requirements
