« The Dual Agenda: November 20, 2014 Issue

Noteworthy News

Care for Massachusetts Dual Eligibles More Complex Than Expected

A Boston Globe article provides a one-year review on the experience of One Care, the Massachusetts dual eligible demonstration project, which began enrolling beneficiaries last October. One Care was the first managed care dual eligible demonstration to roll out, and provides an early barometer of the challenges associated with providing better care to this vulnerable population. Thus far, both health insurers and state regulators are finding that caring for dual eligibles is more complex – and more expensive – than had been anticipated. Initial difficulties are as basic as being able to locate patients, many of whom move frequently or are homeless. Behavioral health issues also loom larger than anticipated. Insurers and regulators are learning as they go, and they are improving. However, if Massachusetts’ experience is at all typical, other states launching demonstrations can anticipate a similar learning curve and slower progress than they may have hoped for. The article also points out that  program evaluation, consumer feedback and learning can help effect needed course corrections.

Brief Highlights Benefits of Risk Stratification in Dual Eligible Demonstrations

A Center for Health Care Strategies brief, made possible with funding from The Commonwealth Fund and The SCAN Foundation, describes how CaliforniaOhio and Virginia are requiring health plans to stratify each dually eligible enrollee by their level of need within their dual eligible demonstrations. The brief concludes that stratifying beneficiaries according to need may help states and plans do a better job of prioritizing the needs of enrollees. The brief details each of the three studied states’ strategies and could be used by other states pursuing either dual eligible demonstrations or other health care integration and innovation efforts.

Providing More Than Medical Care to “Super-Utilizers”

An article in The Morning Call highlights the work of a partnership of caregivers, social workers, clergy and patients in Allentown, Pennsylvania who are using a federal grant provided by the Affordable Care Act to implement an innovative plan designed to address the needs of so-called “Super-Utilizers.” This term refers to people who use the health care system exceptionally heavily, often characterized by multiple emergency room visits and hospitalizations for health issues better treated in less intensive settings. While not targeted specifically at dual eligibles, most Super-Utilizers are chronically ill and low income, and therefore it is safe to assume that these populations overlap. The goal of the Lehigh Valley Super-Utilizer Partnership is to address the social isolation of patients with an eye toward improving their health and lowering costs. The Lehigh Valley program is based upon the innovative work of family physician Dr. Jeffrey Brenner in Camden, New Jersey, but additionally incorporates a strong faith-based component.

California Duals Demonstration at Six Months: Problems Mount as State Pledges It Is Trying to Fix Them

Six months into the implementation phase of California’s largest-in-nation dual eligible demonstration project, Kaiser Health News reports that confusion, anxiety and resistance continue to surround it. The state already has been sued by the Los Angeles County Medical Association, which contends the scale is too large and pace too rapid for a workable demonstration project. The opt-out rate has been quite high, and some beneficiaries feel that they do not have access to adequate benefits, or find barriers to keeping existing provider relationships due to network limitations. The article goes on to discuss other problems the demonstration has encountered during its rocky start including complicated information packets mailed to beneficiaries, confusion over opting out, and the lack of advance outreach to physicians and other providers to help them understand the benefits of the new care model. In addition to sharing some stories of individual consumers dissatisfied with new program, the article quotes Toby Douglas, director of the California Department of Health Care Services, who acknowledges the problems, and says the state is trying to move quickly to address them. 

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