Dual Eligibles: Translating Lessons Learned into Strategies for Delivering High-Quality Care

Presented by Melanie Bella, MBA, at the 2nd Annual CEO Roundtable on September 15, 2016

Dual eligible beneficiaries comprise less than a third of the Medicare and Medicaid populations but are responsible for more than a third of all Medicare and Medicaid spending. States must find new ways to reduce costs and improve the quality of care for dual eligible despite engagement and service integration challenges. Bella's presentation examines strategies that are working well in existing programs, tactics to avoid and key areas where policy reform is needed to best serve these most vulnerable plan members.

Transcript

1. Melanie Bella, MBA
2. Dual Eligibles: Translating Lessons Learned Into Strategies for Delivering High-Quality Care 2
3. Medicare-Medicaid Coordination Office • Section 2602 of the Affordable Care Act • Purpose: Improve quality, reduce costs, improve the beneficiary experience, reduce/eliminate misalignments between Medicare and Medicaid • Three areas of focus: – Program Alignment – Data & Analytics – Models & Demonstrations 3
4. Dual Eligible Beneficiaries as a Share of Medicare and Medicaid Population and Spending, 2008 4 20% 31% 15% 39% 80% 69% 85% 61% Total Medicare Population, 2008: 46 Million Total Medicare Spending, 2008: $424 Billion Total Medicaid Population, 2008: 60 Million Total Medicaid Spending, 2008: $330 Billion Dual Eligibles as a Share of the Medicare Population and Medicare Spending, 2008: Dual Eligibles as a Share of the Medicaid Population and Medicaid Spending, 2008: SOURCE: Kaiser Family Foundation analysis of the CMS Medicare Current Beneficiary Survey Cost and Use File, 2008, and Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on data from FY2008 MSIS and CMS Form-64.
5. Enrollment Snapshot – July 2016 5 Source: Integrated Care Resource Center: http://www.integratedcareresourcecenter.com
6. Opportunities for Integration • Medicaid Managed Long Term Care Plans (MLTC) • Medicare Advantage Dual Eligible Special Needs Plans (SNPs) • Medicare-Medicaid Demonstration Plans (MMPs) • Program of All-Inclusive Care for the Elderly (PACE) 6
7. Financial Alignment Demonstrations • Two models: capitated and managed fee-for-service • Demonstrations have been approved in 13 states: – Capitated (10): CA, IL, MA, MI, NY, OH, RI, SC, TX, VA – MFFS (s): CO, WA – Alternative (1): MN • Enrollment is approaching 400,000 • CMS has offered a two-year extension of demo 7
8. Challenges • Beneficiary location and engagement • Enrollment churn • Provider buy-in • Integration of LTSS, BH and other non-medical services • Rates and incentives • Scaling 8
9. Successes • Positive beneficiary experiences and outcomes • Critical learning about assessments, care plans and care teams • Integrations of LTSS, BH and other non-medical services • Unprecedented level of investment in infrastructure, people and community supports • Meaningful risk adjustment and payment changes 9
10. Promising Practices • Population stratification • Social determinants of health • Housing • Provider risk/incentives • Member engagement • Behavioral health • Community transitions 10
11. Looking Toward the Future • Building/strengthening community relationships • Measuring what maters • Creating more demand in the states • Translating implementation experiences into policy changes – enrollment, marketing, appeals, assessments, etc. • Medicare-Medicaid Plan (MMP) as a permanent option • DSNPS reauthorization • Incentives and level playing fields for plans 11
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