« The Dual Agenda: August 19, 2015 Issue

State Highlights

Massachusetts

MassHealth hosted an open meeting on the One Care program on August 17. Key highlights from the meeting:

• Ensuring appropriate transitions for members enrolled in Fallon Total Care. Fallon will be exiting the One Care program as of September 30, 2015.
• It was announced that the Commonwealth Care Alliance (CCA) is at capacity and will temporarily not be accepting new One Care members. This will not affect current enrollees.
• Tufts Network Health will potentially take on 500 of Fallon’s members in Worcester County through end of 2015. In addition, Tufts is seeking to expand its service area to include Norfolk County and increase its One Care footprint in Suffolk County.
• CMS will be convening a meeting in September with MassHealth, Office of Management and Budget, Office of the Actuary and input from One Care enrollees to discuss the financial structure and payment parameters of One Care.
• MassHealth will be submitting a letter of intent to extend the demonstration for two years. This letter is in response to a recent CMS memorandum inviting all demonstration states to extend their projects.

In other news, presentations made last month to the Implementation Council by two One Care plans, Commonwealth Care Alliance and Fallon Total Care, are now available. Both plans highlighted their experiences and challenges to implementing the One Care program.

New York

The Medicare Rights Center, lead organization in New York for the Voices for Better Health project and organizer of the Coalition to Protect the Rights of New York’s Dually Eligible (CPRNYDE), released a toolkit that provides information about New York’s Fully Integrated Duals Advantage (FIDA) program for health care providers. The toolkit materials are intended to help providers understand FIDA’s promise of care coordination, provider roles in the FIDA program, and how providers can help their patients make the best coverage choices for their needs.

Oregon

A recent blog post by Community Catalyst partners at OSPRIG highlights a new study conducted by the Consumer Confidence Project (CCP), a volunteer-led effort overseen by the Oregon Public Health Institute, with support from the OSPIRG Foundation. The study finds that Oregon’s efforts to transform health care through its Coordinated Care Organizations (CCOs), are not yet delivering on their potential to improve the consumer experience. An analysis of state data suggests that many CCOs are succeeding in keeping costs down and improving quality in key areas like reducing unnecessary emergency room visits. Unfortunately, it also found that the state falls short in helping members navigate the system and in providing information about how decisions are made in the CCO structure. To compile the new study, CCP reviewed publically available data and found that Oregon’s 16 CCOs are doing an uneven job at best of empowering their members and informing the public about their operations.

In addition to the CCP report, the Oregon Center for Public Policy released a separate, complementary analysis of publicly-reported data on how consumers rate their experience at each of the Oregon’s 16 CCOs, which the state has not generally included in its reporting on the progress of the transformation project. Most of the CCOs received a high score in measures like getting needed care and getting timely care, while overall measure of “rating of health” for majority of the CCOs remained low in 2014; though higher than what was reported for this rating category in 2013.

Rhode Island

On August 17 The Providence Journal published an op-ed co-authored by Voices for Better Health project partner Maureen Maigret, consultant for the Senior Agenda Coalition, and the project’s two Rhode Island geriatric provider advocates, Dr. Richard Besdine and Martha Watson. The op-ed highlights the critical need for better coordinated, more integrated care for the Ocean State’s dually eligible population. With a financial alignment MOU between the Centers for Medicare and Medicaid Services and the state signed in July, the op-ed highlights the promise of the important new effort underway in the state to improve care for this population and the opportunity to infuse geriatric best practices into the new model of care for older adults.