Study Highlights Health Plan Innovations in Integrating Care for Medicare-Medicaid Dually Eligible Beneficiaries
FOR IMMEDIATE RELEASE: June 23, 2016
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STUDY HIGHLIGHTS HEALTH PLAN INNOVATIONS IN INTEGRATING CARE FOR MEDICARE-MEDICAID DUALLY ELIGIBLE BENEFICIARIES
Profiled Safety Net Health Plans Serve 3 in 10 Financial Alignment Demonstration Enrollees
WASHINGTON—A new paper released today by the Association for Community Affiliated Plans (ACAP) and the Center for Health Care Strategies (CHCS) provides a snapshot of 14 Safety Net Health Plans participating in Financial Alignment Initiative demonstrations around the country in an effort to provide integrated care for people who qualify for both Medicare and Medicaid benefits. The findings provide lessons for states, plans and providers that are involved in integrated care programs for dually eligible beneficiaries.
The ACAP-member Safety Net Health Plans profiled in the report participate in the demonstrations as Medicare-Medicaid Plans (MMPs)—health plans that provide integrated, coordinated Medicare and Medicaid benefits for dually eligible beneficiaries. Collectively, these 14 ACAP MMPs enroll more than 100,000 beneficiaries, accounting for close to 30 percent of enrollment in MMPs nationwide.
“The opportunities provided by the Financial Alignment Initiative have created a surge of innovation among health plans,” said report co-author Michelle Herman Soper, CHCS Director of Integrated Care. “Some of the plans we profile are expanding the definition of health care to address underlying social determinants, others are rethinking fee-for-service payment arrangements and considering value-based purchasing, and still others are leveraging telehealth technologies to improve care. These innovations are instructive for anyone considering serving dually eligible populations.”
Nationwide, dually eligible beneficiaries account for about 1 in 7 Medicaid enrollees, but more than one-third of all Medicaid health care costs. Accordingly, better integration of care for dually eligible beneficiaries has long been a priority for Federal and state policymakers.
The report highlights several health plan innovations aimed at fulfilling the promise of integrated care across the Medicare and Medicaid program. Such innovations include addressing social determinants of health such as housing; developing value-based purchasing strategies to align incentives toward better quality of care; and addressing complex medical, long-term care, and social needs that have gone unmet by the fragmented Medicare and Medicaid fee-for-service systems.
“There has to be a better way for dually eligible beneficiaries to get comprehensive care than dueling fee-for-service systems,” said ACAP CEO Margaret A. Murray. “Safety Net Health Plans have made real innovations to deliver top-notch care and improve access. They range from telemedicine initiatives that improve access, to crisis centers, to helping address unmet behavioral health needs. These are the kinds of innovations that can take place on an integrated care platform – they are far harder to realize in a fee-for-service system.”
The systemic reform represented by the Financial Alignment Initiative is an inherently significant and complex undertaking. The report highlights a number of lessons and recommended priorities for investment, including establishing close relationships among plans, providers, and state agencies; enhancing care coordination and management activities; sharing information and streamlining administrative processes. Specific efforts include:
- Working to address social determinants of health;
- Investing high levels of effort in locating and engaging plan members to complete care plans;
- Opening channels of communication among physical and behavioral health providers;
- Working with the state to target passive-enrollment strategies to encourage enrollment for certain populations;
- Developing flexible contracting approaches to improve relationships between health plans and providers; and
- Working toward developing tools and strategies to minimize administrative burden for providers.
The report is available in full at www.communityplans.net.
ACAP represents 56 not-for-profit Safety Net Health Plans, which provide health coverage to more than fifteen million people in 26 states. Safety Net Health Plans serve their members through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), the Marketplace and other health programs. For more information, visit www.communityplans.net.
The Center for Health Care Strategies (CHCS) is a nonprofit policy center committed to improving health care quality for low-income Americans. CHCS works with state and federal agencies, health plans, providers, and consumer groups to develop innovative programs that better serve people with complex and high-cost health care needs. Its program priorities are: enhancing access to coverage and services; advancing delivery system reform; and integrating services for people with complex needs. Learn more at www.chcs.org.
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