Alliance for Health Reform Congressional Briefing Washington, D.C. December 12, 2011

1. MassHealth Demonstration to Integrate Care for Dual Eligibles: Member Focus Groups and Stakeholder Engagement Alliance for Health Reform Congressional Briefing Washington, D.C. December 12, 2011 Corrinne Altman Moore, M.P.A. MassHealth/Executive Office of Health and Human Services Commonwealth of Massachusetts

2. Initiative to Integrate Care for Dual Eligible Individuals One of 15 states awarded a $1M planning contract from CMS Center for Medicare and Medicaid Innovation to support the development of a design proposal for a State Demonstration to Integrate Care for Dual Eligible Individuals Purpose is to identify, support and evaluate person-centered models that integrate the full range of acute, behavioral health, and long term supports and services Target population: 115,000 dual eligibles ages 21-64 with full MassHealth and Medicare benefits 2

3. Medicare Services: All Part A, Part B, and Part D services Medicaid State Plan Services Additional Behavioral Health Diversionary Services Additional Community Support Services Integrated Care Management Medical and non-medical services coordinated through multi-disciplinary care teams Members play an active role in care planning and decisions Proposed Benefit Design 3 3

4. Integrated care organization (ICO) baseline requirements: Foundation of person-centered medical homes, with core competencies in team-based care, care coordination Highly developed acute, primary care, behavioral health, and long term services and supports provider networks Health information technology Global payment for all MassHealth and Medicare services for acute and primary care, behavioral health and community support services Contracted ICOs must demonstrate experience and competencies in serving individuals with disabilities, chronic behavioral health diagnoses, and chronic medical problems Proposed Delivery Model 4

5. Stakeholder Involvement Regular consumer-focused meetings (7 to date) since March 2010 Open public meetings (3 to date) in Boston and Worcester, with robust participation Member focus groups (4, randomly selected) Public presentation of data analysis on the profile of dual eligibles age 21-64, sponsored by MMPI Outreach to disability community and advocacy groups, such as: Potter Place Clubhouse Massachusetts Advocates Standing Strong (MASS) Disability Advocates Advancing our Healthcare Rights (DAAHR) M-Power The Transformation Center Boston Health Care for the Homeless Program Public facing website and email address 5 5

6. Focus Groups Conducted in Summer 2011 • Four focus groups of dual eligible members ages 21-64 convened to discuss current benefits and the idea of an integrated model • Rich variation in geography, urban vs. rural location, and primary language • Valuable perspectives and input, including positive comments about some current benefits and areas that need improvement • Results have been summarized and presented to stakeholders, and are being considered in our design decisions

7. Working Well: Primary and specialty care Hospital services Medical transportation PCA Services Low out-of-pocket cost Range of covered services Opportunities: Dental services/ Eyeglasses Mailings and materials Customer service Annual eligibility reviews Durable Medical Equipment (DME) quality and compatibility Limits on physical therapy Limits on covered medications Case management Focus Groups: Positive Impressions and Opportunities from Health Care Experiences

8. Positive Change: Eliminate waste; redundancy Save money on duplicative administrative costs Reduce bureaucratic overlap Increase information sharing between two agencies To Make it Attractive: Include current providers Level cost-sharing for Rx Ensure continuity of care Include all current benefits Make accessing services simple Member control over care decisions Improve dental, eyeglasses, DME, care coordination Inform members about change Focus Groups: Integrated Care Model

9. Demonstration Features Developed from Focus Groups, Stakeholder Feedback Benefit Design: Improve current benefits: Dental Services, Eyeglasses, DME Add key benefits: Peer supports, nutrition and wellness, community health workers Enrollment Process and Outreach: Neutral/impartial enrollment broker Sufficient time and clear information to make a choice Provider Networks: Preserve connections to current providers and caregivers Require entities to continually enroll providers that meet network requirements 9 9

10. Visit us at www.mass.gov/masshealth/duals Email us at Duals@state.ma.us