Building anything new is tough. That’s why we turn to blueprints and experts.

The same principle applies to the federal demonstration projects for people eligible for Medicaid and Medicare (dual eligibles) that are under construction in more than 20 states across the country. These projects are building complex new systems of care for millions of the most vulnerable people in the nation that are supposed to combine services paid for by both Medicaid and Medicare into a coherent, coordinated program. Fortunately, the federal government is supplying sketches for the states to work from, and requiring states to consult the experts – in this case, the consumers who will be served.

But to help these projects succeed, the states and the delivery systems that will operate these projects need a detailed blueprint for how best to engage those consumer experts. Today, Community Catalyst is supplying that blueprint, A Seat at the Table: Consumer Engagement Strategies Essential to the Success of State Dual Eligible Demonstration Projects, drawing on engagement that’s working elsewhere.

The blueprint starts with the federal requirement already in place that each state establish a plan for meaningful consumer input in the demonstrations. Then, it adds structures at the federal, state, delivery system and community levels to ensure consumers and their family members are at the decision-making tables, shaping the projects, and helping to fix flaws before they can undermine the whole enterprise.

Key elements of the blueprint:

  • Detailed state plan for consumer engagement in formal oversight, planning and monitoring of everything from enrollment practices to provider networks to quality improvement. This includes broad consumer membership on statewide oversight councils and workgroups, requirements for managed care companies (MCOs) and managed fee-for-service delivery systems to implement engagement strategies, and established timetables and mechanisms for collecting feedback from individual consumers
  • MCO and delivery system inclusion of consumers on their governing boards or establishment of consumer advisory committees
  • State measurement of the effectiveness of consumer engagement as part of quality assurance and adjustment of both the engagement plan and implementation as needed. Measures might include program changes resulting from consumer engagement, the number of consumers engaged at each stage and each level, and the degree to which those involved reflect the diversity of the demonstration population
  • Federal funds made available to states for consumer engagement activities
  • Training for consumers to help them be effective in these roles
  • Stipends for consumer time and travel to participate
  • All consumer engagement conducted in a manner fully accessible to those with disabilities, and linguistically and culturally competent
  • Consumer membership on oversight or advisory committees that reflects the diversity of participants in the demonstration projects
  • CMS oversight to ensure follow-through

More details and examples are included in the full blueprint. In addition, other resources on consumer engagement in delivery systems are available in a separate Community Catalyst report. To fully build this out will require federal and state policymakers, MCOs, delivery systems and consumers working together. Advocates can help by urging full adoption of the blueprint.