Progress Made, More Needed in Dual Eligible Demonstration Projects
Recently, CMS’ Medicare-Medicaid Coordination Office (MMCO) released a new report on the progress of the Financial Alignment Initiative. Through this initiative, thirteen states are running demonstration projects focused on improving care for vulnerable Americans enrolled in both Medicare and Medicaid, sometimes referred to as “dual eligibles.” In most states participating in the initiative, dual eligibles are enrolled in managed care plans responsible for all aspects of their care, while in two states, they are part of health homes responsible for coordinating their care.
The new MMCO report examined enrollees’ experiences in the demonstrations in seven early-launch states – California, Colorado, Illinois, Massachusetts, Ohio, Virginia and Washington – and was based on data collected in 2015.
Those of us who have been following these demonstrations for the last several years have been awaiting these sorts of results with baited breath. So, I dug right in.
For the most part, the results seemed pretty promising: most enrollees reported good (though not always quick) access to needed care and prescription drugs and had favorable views of their health plans or health homes.
However, one category of findings really stood out for me – those around care coordination. Care coordination is the lynchpin of the demonstrations, aimed at countering the system’s fragmentation caused by the separate financing and benefit structures of Medicare and Medicaid as well as the complex health needs of many beneficiaries. Yet only 30 percent of enrollees in managed care plans recalled receiving help from their health plan and/or providers in coordinating their care. And, only 54 percent of enrollees in Washington and 62 percent in Colorado (the two health home demonstrations) indicated that they were usually or always helped by someone on their care team to make a treatment plan or plan ahead to take care of their condition. These findings echoed reports over the past year from the Government Accountability Office, an Early Indicators Project in Massachusetts, a consumer survey in Ohio and our own survey of ACAP health plans. Similarly, new evaluation results of the California demonstration project released this week found that only 34 percent of enrollees reported having a care coordinator and 40 percent of enrollees didn’t even know they could get care coordination.
We can do better, and not only in the context of these demonstrations. Care coordination, particularly for people with complex medical, behavioral and/or social service needs, must be at the heart of any delivery system reform. It should encompass comprehensive assessment, planning with the consumer and culturally-competent, team-based care.
By its very definition, any demonstration is a work-in-progress. Let’s take the learning shared in this and other evaluations, capturing the real experiences of dually eligible consumers, and find new ways to get more beneficiaries engaged in high-quality care coordination.