On June 1st, with the generous support of The Atlantic Philanthropies, The John A. Hartford Foundation and the Robert Wood Johnson Foundation, Community Catalyst brought together advocates, providers, policymakers, funders, and technical experts to discuss the proposed demonstration projects to integrate care for people who are dually eligible for Medicare and Medicaid (“dual eligibles”). These demonstration projects are a joint federal and state experiment to test whether it is possible to reorganize the way services are delivered and financed for dual eligibles, and to simultaneously improve the quality and stabilize the cost of their care. Twenty-six states have submitted proposals, and advocates from 13 of those states were at the conference.

Dual eligibles are among the most vulnerable people in the country. Care for them is complex, often necessitating long-term services and supports. Conference participants heard about the opportunity of these demonstrations from innovative mission-driven programs like from PACE (Program for All Inclusive Care For the Elderly) which is operational in 29 states, and plans like the Commonwealth Care Alliance in Massachusetts, and Independence Care in New York, which have been successful in caring for people who are dually eligible.

Conference participants also discussed the risks involved in reorganizing the health of this vulnerable population. Implementation will be challenging and there are “sharks in the water.” The dual eligibles have gotten the attention of some governors, who are concerned about holes in their budget, and of insurers, who have previously shown no interest in serving this population. Many of the proposed state plans are not well developed. Conference attendee Chris Langston, Program Officer for The Hartford Foundation, blogged about a number of these risks after reviewing three of the state plans: “We are on the verge of putting millions of people into new but untested financing and delivery models in a period of unprecedented budget strain and financial disruption,” he writes.

Participants also wrestled with difficult technical issues such as establishing meaningful quality measures and creating appropriate payment mechanisms to promote better care. They also had the opportunity to hear from Melanie Bella, Director of the Medicare-Medicaid Coordination Office, and others from CMS and HHS who were at the conference to hear the concerns and answer questions.

The dual demonstration project could be one of the most significant provisions of the Affordable Care Act. It could provide the opportunity to improve the lives of duals and to stabilize costs. But everyone at the conference acknowledged the need for continued connection, support and resources for advocates, who will play an important role in ensuring new care models are responsive to the specific needs of the people being served.

— Rob Restuccia, Executive Director