Maximus, Inc. · NYSE:MMS
Maximus — Duals Demonstrations Webinar (May 2015)
31 slides from Maximus's conference presentation, May 28, 2015
Slide 1: Lessons Learned from the Dual Eligibles Demonstrations
May 28, 2015 Lessons Learned from Real-Life Takeaways the Dual Eligibles from California Demonstrations and Other States 1
Slide 2: Introductions
Introductions Toby Douglas Barbara Selter Consultant, MAXIMUS Vice President, MAXIMUS Former Director of California Department of Market Lead for Long Term Services and Health Care Services (Medicaid Director) Supports 2
Slide 3: Webinar Goals
Webinar Goals • Gain an understanding about the Financial Alignment for Duals Demonstrations • Learn about the California Coordinated Care Initiative as a an early adopter of integrated care for Medicare-Medicaid Eligibles • Provide lessons learned and best practices for other states seeking to bett
Slide 4: Overview of States Participating in Demonstrations
Overview of States Participating in Demonstrations • MAXIMUS assisted states: – California – Colorado – Illinois – Massachusetts – Michigan – New York – South Carolina – Texas – Virginia Differences among demonstrations: – InfoCrossing Interfaces – State or MAXIMUS responsibility – Outreach – Stat
Slide 5: Why states participate in the Duals Demonstration?
Why states participate in the Duals Demonstration? • Streamline the consumer experience....one card, one program, one plan • Unify member protections • Allow for state oversight of all program benefits • Guarantee state saving 5
Slide 6: California Coordinated Care Initiative Overview
California Coordinated Care Initiative Overview • 1.1 million dually eligible beneficiaries in California • More than 70% are over 65 • 34% have 1 or 2 chronic illnesses and 15% have 5 or more • Less than 20% were in organized delivery system • Account for about 25% of overall Medi-Cal spending vers
Slide 7: Overview: The Coordinated Care Initiative
Overview: The Coordinated Care Initiative • Cal MediConnect -Combines Goals: Medicare and Medi-Cal benefits • Maximize the ability of into one managed care plan beneficiaries to remain in their • Managed Long-Term Services homes and communities, with and Supports - Provides Medi- appropriate service
Slide 8: Overview (continued)
Overview (continued) • Beneficiaries are passively enrolled into Cal MediConnect plan, unless they choose to opt out • Beneficiaries are notified about the program 30, 60, and 90 days before they are enrolled • Phased-in enrollment over 12 months in each county, starting with San Diego, San Bernardi
Slide 9: Network Strategy – The Delegated Model
Network Strategy – The Delegated Model • Health plans delegate certain functions (e.g., care management) to another health plan or physician group. • Delegation is a way to share risk and allows for a reasonable division of administrative and clinical management. • Delegated entities are paid a capi
Slide 10: Network Strategy
Network Strategy • Organized care delivery system – Built off Medi-Cal Managed Care & Medicare Dual Eligible Special Needs Plan (D-SNP) Model for traditional medical services – Behavioral Health integration • Long-Term Services & Supports (LTSS) provider network – Including Long-Term Care facilities
Slide 11: Network Strategy (continued)
Network Strategy (continued) • Contracting with medical groups and hospitals – Contract documents/amendments, inclusive of participation requirements o Health Risk Assessment (HRA) / In-Home Assessment (IHA) requirements o Specific requirements for encounter reporting o Specific requirements for qua
Slide 12: Implementation of the Coordinated Care Initiative
Implementation of the Coordinated Care Initiative • Stakeholder Engagement – Statewide and local stakeholder coalitions funded by – Coordinated Care – The SCAN Foundation Crucial for better healthcare – Beneficiary and provider outreach conducted by state contractors – Online clearinghouse with reso
Slide 13: Key Aspects of the Coordinated Care Initiative
Key Aspects of the Coordinated Care Initiative • Person-Centered Care Coordination – Health Risk Assessments (HRAs) and care planning – Interdisciplinary Care Teams – Integration of medical care, behavioral care, and long-term services and supports • Beneficiary Protections – Multiple notices, dedic
Slide 14: Integration of Long-Term Services and Supports
Integration of Long-Term Services and Supports • Pre-CCI: – Medicare paid for: office visits, hospitalizations, and prescription drugs – Medi-Cal paid for: LTSS and cost sharing – No mechanisms or incentives to manage utilization or keep beneficiaries out of institutional long-term care • CCI: – Cal
Slide 15: Care Planning: Health Risk Assessments (HRA)
Care Planning: Health Risk Assessments (HRA) • Health plans are required to complete an HRA for every Cal MediConnect member • Medicare and Medicaid claims data is shared with health plans prior to coverage effective date • Plan-specific risk stratification process based on utilization and health ou
Slide 16: Provider Group Support: Data Exchange
Provider Group Support: Data Exchange • Data are used by provider groups to incorporate into their: – Case management systems – Electronic medical records – Workflow tools – Analytics engines. 16
Slide 17: Current Enrollment Data for Cal MediConnect
Current Enrollment Data for Cal MediConnect • 122,520 dually eligible beneficiaries enrolled as of April 1, 2015 • 49% of beneficiaries opt-out before they are passively enrolled as of March 2015 • 63% of beneficiaries with IHSS services opt-out • Passive enrollment goes through June 2015 in Los Ang
Slide 18: Successes
Successes • Created a system that is easier to navigate • Reduced fragmentation, confusion, waste for highest-need clients • Member Coordinated Care and Satisfaction • Provider Group Engagement • Coordination with County Agencies • Extensive Training – internal, provider, stakeholder • Data Integrat
Slide 19: Challenges and Opportunities In California
Challenges and Opportunities In California • Opt-outs – Confusion around managed care and misinformation campaigns – Ongoing provider outreach and education – Ongoing beneficiary and stakeholder engagement • Care Coordination – Locating beneficiaries for the HRA process – Integrating LTSS providers
Slide 20: Other Dual Demonstration States
Other Dual Demonstration States 20
Slide 21: Key Challenges – Opting Out
Key Challenges – Opting Out • Opting-out by part of population: – Beneficiaries are confused or do not want to change – Providers are actively “opting-out” for their patients – mass opt- outs – Providers have limited time to understand the benefits to their patients and are concerned this will affec
Slide 22: Feedback from the Projects on Opt-Out
Feedback from the Projects on Opt-Out • Period of Opt-Out: – Biggest opt out rate between 60-day and 30-day notice – 60-day letter often drives the opt-out – Limited opt-out after enrollment • Key opt-out reasons: – Suggestion from nursing facility, PMP, or specialist – “It’s all too confusing…” – S
Slide 23: Key Challenges – Communication with Stakeholders
Key Challenges – Communication with Stakeholders • Communication with Key Stakeholders – Beneficiaries o Elderly are not easily located o Notices may be too complex and dense, so active outreach is really needed o Many are fearful and do not want to change from their current plans – Providers o Do n
Slide 24: Key Challenges – Data Management
Key Challenges – Data Management • System interfaces, data integrity, and data reconciliation − Excluded groups (Vets, HIV/AIDs, ID/DD populations and others) − Reconciliation with Federal, State, and vendor systems 24
Slide 25: Best Practices – Incorporate Early Feedback
Best Practices – Incorporate Early Feedback • Better define the benefits to the beneficiary and provider of participating in these programs – “One card” argument is not enough – Providers are not aware of benefits to their patients and do not understand rates • Get early feedback from the stakeholde
Slide 26: Best Practices – Enhancing Outreach Pays Off
Best Practices – Enhancing Outreach Pays Off • Beneficiary outreach – Conduct Town Hall Events – Provide webinars – Attend community events like health fairs – Conduct customer satisfaction surveys and focus message on beneficiary feedback – Provide more face-to-face assistance – Perform outbound ca
Slide 27: Best Practices – Improving Communications
Best Practices – Improving Communications • Enhanced scripting, especially for those opting-out, helps enrollment – Scripting needs to emphasize the benefits to the beneficiary of participating in the Integrated Care Pilots – Require the beneficiary to go through opt-out script and confirm changes –
Slide 28: Best Practices – Managing Data
Best Practices – Managing Data • Work more closely with 1-800-MEDICARE and establish protocols for sharing data • Implement real time interfaces and comprehensive data reconciliation processes to address data inconsistencies, which reduces calls 28
Slide 29: A Look Ahead….
A Look Ahead…. • Leveraging lessons learned by the later states – smoother implementations and fewer opt outs • Pilot evaluations and state/federal decision about whether to continue the demonstration projects • Adoption of the different models by additional states – Duals Special Needs Plans Model
Slide 30: Questions | Discussion
Questions | Discussion DECISIONPoint™ MAXIMUS
Slide 31: Thank You!
Thank You! To view the recording of this webinar and others, please visit: www.maximus.com/webinars 31