Integrated care programs offer promising options for improving care delivery for more than 10 million Americans dually eligible for Medicare and Medicaid. Through the federal Financial Alignment Initiative, 13 states are implementing demonstrations to test coordinated, person-centered approaches in place of the fragmented care typically provided in fee-for-service delivery systems. However, shifting to an integrated system of care takes time. Keeping beneficiaries, providers, legislators, and other relevant internal and external stakeholders informed along the way can help states maintain support and reduce provider resistance.
The Centers for Medicare & Medicaid Services (CMS), states, and health plan partners have worked hard to get the demonstrations up and running. Currently, more than 450,000 dually eligible individuals across the country are enrolled in integrated care through the demonstrations. These new programs, which have hired more than 2,500 care managers across nearly 70 health plans, serve as models to transform the nation’s delivery system for this very high-cost, high-need population.
CMS recently released initial findings from Washington State’s managed fee-for-service model demonstration, which uses health homes to coordinate Medicare and Medicaid services. Washington achieved a $21.6 million reduction in Medicare spending in the first 18 months of the demonstration. These early savings are promising, and CMS-funded preliminary evaluations for other states’ demonstrations will follow later this year.
Approaches to Sharing Early Program Results
While they wait for federal evaluation results, states are sharing their own early program findings with stakeholders to build demonstration support and enrollment. Seven states — Arizona, California, Florida, Massachusetts, South Carolina, Texas and Virginia — participants in the Center for Health Care Strategies’ (CHCS) INSIDE project supported by The SCAN Foundation and The Commonwealth Fund, recently shared their approaches for communicating early results of integrated efforts. Following are successful strategies:
- Sharing results of early beneficiary experience
Since the launch of Massachusetts’ demonstration, One Care, the state has assessed beneficiary experience through focus groups and surveys under the One Care Early Indicator Project. One Care health plans and the state’s Implementation Council, a stakeholder advisory group, also reviewed beneficiary feedback to find ways to improve beneficiary experience. For example, Massachusetts found that although enrollees were generally satisfied with One Care and intended to stay enrolled, better communication was needed to help them understand One Care’s model and empower them in care planning.
In California’s Cal MediConnect demonstration, the state is working with university and foundation partners to review beneficiary feedback, including reasons for opting in or out of the program. Data from rapid cycle polling and the first phases of a multi-year evaluation show that beneficiaries are satisfied with the demonstration. These results, which were shared with a broad group of stakeholders, have helped build support for the program.
- Spotlighting beneficiary and provider champions
Transitioning from fee-for-service can be a hard sell for providers new to managed care. The same is true for beneficiaries who may not understand the value of integrated care or may be fearful of potential care disruptions—even when the state establishes continuity of care provisions. In response, states are spotlighting beneficiaries’ and providers’ positive experiences.
California found provider champions who could share their experiences with other providers. During a 2015 Cal MediConnect provider summit, a primary care physician described the value of Cal MediConnect’s care coordination and data sharing efforts to more than 200 providers and provider representatives. Similarly, South Carolina’s member stories web page highlights how individuals have benefited from its Healthy Connections Prime demonstration. These first-person stories illustrate the program’s impact in a concrete way that speaks to beneficiaries, caregivers, advocates and providers.
- Sharing key indicators of early program performance
A number of states are using public dashboards to share key program performance indicators, including enrollment and completed health plan assessments. For Virginia’s demonstration, Commonwealth Coordinated Care (CCC), the state developed a care management performance dashboard that shows care plan completion rates. In its first year, CCC health plans completed 92 percent of enrollee assessments within the target date.
Earlier this month California released a performance dashboard that highlights Cal MediConnect health plan performance in six areas: (1) health risk assessments; (2) appeals by determination; (3) hospital discharge; (4) emergency utilization; (5) long-term services and supports use; and (6) case management. As an example of measures in the dashboard, in a recent reporting period, 61 percent of patients discharged from the hospital had an outpatient follow-up visit within 30 days, an important indicator that can lead to better health outcomes.
Making the Case for Continued Innovation
Informed stakeholders understand that it will take time for care delivery innovations to impact the quality and cost of care. Adjustments will be needed as states share early program performance data with stakeholders and as state and federal evaluation reports are released. While data from comprehensive evaluations of the demonstrations are still necessary, early program results are encouraging and help make the case for continued state investments to improve care for this vulnerable population.
