Early Indicators Project (EIP) UpdateOne Care Implementation Council

By: EIP WorkgroupJanuary 31, 2014

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The Early Indicators Project (EIP) Overall Goal

Assess early perceptions and experiences of MassHealth members eligible for One Care using multiple methods

Distinct from One Care programmatic evaluation or quality measures

Qualitative data sources Five focus groups (two completed) Two surveys (one completed)

Quantitative data sources MassHealth enrollment data MassHealth Customer Service SHINE (Serving the Health Insurance Needs of Everyone) One Care Ombudsman One Care plans

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EIP Workgroup Workgroup is made up of 4 members of the

IC, 3 MassHealth staff and 2 UMass Medical School staff; meets bi-weekly

IC representation Olivia Richard Ted Chelmow Jeff Keilson Dennis Heaphy

Workgroup members develop focus group and survey questions, determine methodologies, identify indicator elements, and develop reports

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Today’s Update

Very Preliminary FindingsFirst two focus groupsOne Care Survey #1One Care Enrollment Indicators

Next Steps for EIP

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One Care Focus Groups 1&2

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Goal - understand perceptions and experiences of members enrolling in or opting out of One Care

Members invited by phone to participate Selected from a randomly-generated list of members living in the

target area Confidentiality of information and voluntary nature of group

emphasized Focus group questions explored

Knowledge of One Care/Information about One Care Making the Decision to Enroll in or opt out of One Care Hopes for (Concerns about) One Care

Boston Focus Group – Chose to Enroll in One Care December 16, 2013; 7 participants (13 registered)

Worcester Focus Group – Chose to Opt-out of One Care December 19, 2013; 5 participants (9 registered)

Discussions audio-recorded; recordings are being transcribed

Preliminary Findings Self-selected members focus group (Boston)

Knowledge of and Information about One Care All participants felt they understood One Care All recalled receiving One Care Enrollment Packet All found information clear and easy to

understand

3 of the 7 participants had contacted MassHealth Customer Service and found CST to be helpful

None had contacted SHINE6

Preliminary Findings Self-selected members focus group (Boston)

Making the Decision to Enroll in One Care Most participants made efforts to confirm that

providers, pharmacies and medications would be covered

Most discussed the decision with a primary care provider, family member or CST before deciding

Reasons for Enrolling Less expensive co-payments for prescriptions Having a care coordinator Better dental coverage One insurance/one insurance card

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Preliminary Findings Self-selected members focus group (Boston)

Hopes for/Experiences with One Care Care coordination – of the 7 participants:

3 participants had met with care coordinator Positive interaction – “She’s very nice…she gave me her phone

number and told me if I needed anything to just give her a call…” 2 participants had been contacted by care coordinator and were

working to schedule initial meeting 2 participants had not yet heard from care coordinator

LTS Coordinator – of the 7 participants: 3 participants used LTSS; none had met with LTS coordinator 1 participant noted that the care coordinator said that LTS

coordinators are “just starting up” All seemed satisfied with One Care, but acknowledged that

it is early – “I have yet to lean on them for major services”

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Preliminary Findings Opted-out members focus group (Worcester) Knowledge of and Information about One Care

All were familiar with One Care – of the 5 participants: 3 recall receiving Enrollment Packet; 2 only recall receiving a

letter All had a basic awareness of what One Care offers Concerns about One Care information

Enrollment guide was “too generic…not specific enough” “The letter just scared me…it basically said that One Care will

replace your existing Medicare and MassHealth. I don’t want to replace it…if you want to add stuff to it, that’s fine…”

One Care website does not provide enough information. It needs: List of providers that are part of One Care List of medications covered under One Care

2 of the 5 participants had contacted CST; none had contacted SHINE

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Preliminary Findings Opted-out members focus group (Worcester) Deciding Not to Enroll in One Care

General consensus -- “If it’s not broke, don’t fix it” Participants felt more secure having Medicare and

Medicaid Allows flexibility to explore treatments Medicaid will back-up and pay for things Medicare will not Some had providers that were not in One Care, or

providers didn’t know if they were in One Care Most participants had not attempted to confirm of

medications were covered 2 of the 5 participants use LTSS (PCA services)

LTS Coordinator role is appealing, but not enough for them to enroll in One Care

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Preliminary Findings Opted-out members focus group (Worcester) Concerns about One Care: Participants

thought they might… Lose current doctors and medications Not get care when needed for their complicated

medical conditions Have to wait for approvals for treatment Have to wait to get appointments with One Care

providers Not be able to reach their Care Coordinator when

needed One Care is new and unknown

“…it doesn’t have any history behind it, so you really don’t know what is going to happen in a year or two.”

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Focus Group Participants Demographic information was collected from

participants and will be provided in final report on One Care Focus Groups

Demographic and background information includes: Age, gender, race, ethnicity, sexual orientation Education and employment Primary disability Use of durable medical equipment Use of/need for ADL assistance Use of hospital, emergency room and LTSS in past year Recent experience of homelessness

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One Care Survey #1 Examined members’ perceptions and experiences

of One Care during initial enrollment period Covered 5 major areas:

MassHealth’s One Care Enrollment Information and the Enrollment Process

Members’ Decision-Making Regarding One Care Reasons for enrolling Reasons for opting-out Reasons for waiting

Limited inquiry about early experiences in One Care (for those enrolled)

Getting Answers to Questions About One Care Demographic, Background and Disability Information

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One Care Survey #1 Administered as telephone interview to 3 groups of

randomly selected members eligible for One Care (n=300) Self-selected into One Care (Opt-in Group) Opted-out of One Care (Opt-out Group) Neither opted-in nor opted-out (Waiting Group)

300 interviews completed by UMMS Office of Survey Research from December 16th to January 20th 109 members who opted-in 125 members who opted-out 51 members who are “waiting” 15 members who were not sure which group they were in

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15 Note. All values are percentages; *Respondents could identify more than one source, so totals exceed 100%.

Table 1. Respondents’ Perceptions of and Experiences with Information about One Care

    Group  Opt-In

(N=109)Opt-Out(N=125)

Waiting(N=51)

MassHealth Enrollment Information/Process % % %MassHealth One Care Enrollment Packet      

Remember receiving packet 90.8 86.4 72.6 Reviewed Information 90.9 88.9 64.9

  Ease of understanding OC enrollment guide

     

Very easy/somewhat easy 83.3 72.9 58.3 Somewhat difficult /very difficult 12.2 21.9 37.5

  Ease of understanding OC enrollment form

     

Very/somewhat easy 83.3 72.9 58.3 Somewhat /very difficult 12.2 21.9 37.5

  Importance of info in deciding about OC

     

Very/somewhat important 81.1 72.9 58.3 Not very/not at all important 6.7 15.6 29.2

         *Getting General Information About One Care      

Called MassHealth Customer Service 33.9 34.4 7.8Called or met with SHINE counselor 19.3 6.4 0.0

Attended community info session/health fair 6.4 7.2 3.9Spoke to rep from One Care plan 56.9 16.0 3.9

Spoke to doctor or other provider 41.3 34.4 21.6Got info from someone else 12.8 14.4 5.9

None of the above 12.8 36.8 62.8

16 Note. All values are percentages; *Respondents could identify more than one reason, so totals exceed 100%.

Table 2. Respondents’ Reasons for Decisions about One Care  Group  Opt-In

(N=109)Opt-Out(N=125)

Waiting(N=51)

Reasons for Decision About One Care % % %*Reasons for Enrolling (Opt –in)      

To get better services 80.7 - -To get additional services 76.2 - -

To get less complicated health care 71.6 - -To lower my health care costs 71.6 - -

To have a care coordinator 52.3 - -Someone recommended it 41.3 - -

Other reasons 31.2 - -*Reasons for Not Enrolling (Opt-out)  

Happy with health care/One Care won’t be as good

- 76.0 -

Would lose an important provider - 68.8 -Would lose an important service - 56.0 -Care would be more complicated - 51.2 -

Didn’t find answers to my questions about One Care

- 24.8 -

Would have to pay more for health care - 23.2 -Someone recommended it - 24.8 -

Other reasons - 33.6 -*Reasons for Waiting to Decide (Waiting)      

Need more time to decide - - 84.3Not sure what to do next - - 70.6

Want to discuss with someone first - - 68.6Need more information - - 68.6

Other reasons - - 29.4

Survey #1 Respondents Demographic information was collected from

survey respondents and will be provided in final report on Survey #1

Demographic and background information includes: Age, gender, race, ethnicity, sexual orientation Education and employment Primary disability Use of durable medical equipment Use of/need for ADL assistance Recent experience of homelessness

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One Care Indicators Data will be collected from a variety of entities

MassHealth One Care plans Customer Service SHINE Ombudsman

Refined data elements based on ideas previously generated by the Implementation Council

Brief summary reports will be available starting in January

Dashboard will be developed 18

Total Enrollment

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Effective January 1, total number of enrollees: 9,506 5,319 self-selection enrollments 4,187 round one auto-assignment enrollments (C1 only)

Total Enrollment by Plan

Commonwealth Care Alliance (CCA) 6,120

Fallon Total Care (FTC) 2,570

Network Health 816

Total 9,506

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total eligible members = approx. 82,000

*Auto-assignment round one effective date, January 1, 2014

*

*

Enrollment Over Time

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Total Enrollment by County

County

New enrollments for Jan. 1,

2014Total

Enrollment

Essex † 57* 571

Franklin † 7 59

Hampden 1,561 2,326

CCA 711 (46%) 1,319 (57%)

FTC 850 (54%) 1,007 (43%)

Hampshire 249 347

CCA 73 (29%) 138 (40%)

FTC 176 (71%) 209 (60%)

Middlesex †

120 810

Norfolk † 60 366

Plymouth † 34 250

Suffolk 1,264 2,087

CCA 1,070 (85%) 1,734 (83%)

NH 194 (15%) 353 (17%)

Worcester 1,673 2,689

CCA 393 (23%) 874 (33%)

FTC 1,073 (64%) 1,354 (50%)

NH 207 (12%) 461 (17%)

All Counties

5,026 9,506† CCA only total eligible members = approx. 82,00021

F1 – Facility-based Care. Individuals identified as having a long-term facility stay of more than 90 days

C3 – Community Tier 3 – High Community Need. Individuals who have a daily skilled need; two or more Activities of Daily Living (ADL) limitations AND three days of skilled nursing need; and individuals with 4 or more ADL limitations In CY2014, C3 split into two subsets:

C3B: for C3 individuals with certain diagnoses (e.g., quadriplegia, ALS, Muscular Dystrophy and Respirator dependence) leading to costs considerably above the average for current C3

C3A: for remaining C3 individuals C2 – Community Tier 2 – Community High Behavioral Health.

Individuals who have a chronic and ongoing Behavioral Health diagnosis that indicates a high level of service need In CY2014, C2 split into two subsets

C2B: for C2 individuals with co-occurring diagnoses of substance abuse and serious mental illness

C2A: for remaining C2 individuals C1 – Community Tier 1 Community Other. Individuals in the

community who do not meet F1, C2 or C3 criteria

One Care Rating Category Definitions

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Total Enrollment

F1 15

C3B 95

C3A 697

C2B 190

C2A 992

C1 7,515

Unavailable* 2

Total 9,506

Total Enrollment by Rating Category

*Rating categories for two enrollments were unavailable at the time of this report.

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Rating Category Enrollment by Plan

F1 represents <1% of enrollments in each plan

This chart includes the first wave of passive enrollments, effective Jan. 1st

MassHealth only passively enrolled individuals in the C1 rating category in the first wave

As a result, the One Care plans’ percentage of C1 enrollments is inflated (for example, FTC’s C1 enrollment is very high because passive enrollments represent over three-quarters of its total enrollment)

The distribution of rating categories across plans will likely shift as assessments and future passive enrollment waves are completed

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Opt-Outs Total number of opt-outs as of

January 1st -- 15,567 Will be excluded from any

future auto-enrollment If eligible, can choose to enroll

by self-selection at any time

Total opt-out number includes individuals who may be ineligible

Of the individuals who received a One Care enrollment package, ~19% have chosen to opt out

Of individuals who previously opted-out, 257 subsequently have chosen to enroll in One Care

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Total Opt-Outs by County

Essex 1,950

Franklin 316

Hampden 2,484

Hampshire 597

Middlesex 2,856

Norfolk 1,205

Plymouth 903

Suffolk 2,057

Worcester 3,127

Non-Demo Counties 72

Total 15,567

Next Steps in EIP 3 additional focus groups will be conducted March-May 2014

Auto-enrollees; Spanish speaking enrollees; enrollees with intellectual disabilities and their caregivers

Final report in July 2014 Finalization of Survey #1 Report – February 2014 Fielding of Survey #2 – May 2014-December 2015

3,000 self-selected and auto-assigned enrollees More comprehensive survey on continuity of care; assessments and

care plans; Care Coordinator/LTS Coordinator experience; successes/problems

Telephone and mail, English and Spanish Fielded in waves, approx. 120 days after each auto-assignment wave Final report in March 2015

Ongoing indicator reports; eventual quarterly “dashboard” Findings will be published on One Care website as available

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Next Steps in EIP

Early Indicators Public Information

Information presented today will be posted on the One Care website; click on News and Community section www.mass.gov/masshealth/onecare

Indicator Reports posted by next week

Focus Group results will be posted within next 2 weeks

Survey #1will be posted once finalized in February 27