Integrated Care Initiatives

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Integrating Physical and Behavioral Health Care: Promising Medicaid Models

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Many individuals receiving care for behavioral health conditions also have physical health conditions that require medical attention, and the inverse is also true. Unfortunately, our physical and behavioral health care systems tend to operate independently, without coordination between them, and gaps in care, inappropriate care, and increased costs can result. This brief examines five promising approaches currently underway in Medicaid to better integrate physical and behavioral health care.



Promoting Integrated Care for Dual Eligibles (PRIDE)

The Center for Health Care Strategies (CHCS) has announced Promoting Integrated Care for Dual Eligibles (PRIDE), a consortium of high-performing health care organizations committed to serving individuals dually eligible for Medicare and Medicaid. Through support from The Commonwealth Fund, CHCS is convening this consortium to identify and test innovative strategies to provide high quality care for these beneficiaries.



Medicaid Accountable Care Organization Program Design Characteristics

Accountable care organizations (ACO) offer an innovative way to transform the current care delivery system and maximize quality and efficiency of care. With support from The Commonwealth Fund, the Center for Health Care Strategies (CHCS) worked with several states through Advancing Medicaid Accountable Care Organizations: A Learning Collaborative to accelerate ACO program implementation. This technical assistance tool presents key features and requirements for ACO programs in six of the participating states: Maine, Massachusetts, Minnesota, New Jersey, Oregon, and Vermont.



HHS Releases Findings on Delivery System Reforms

Today, the Centers for Medicare & Medicaid Services (CMS) released findings on a number of its initiatives to reform the health care delivery system. These include interim financial results for select Medicare Accountable Care Organization (ACO) initiatives, an in-depth savings analysis for Pioneer ACOs, results from the Physician Group Practice demonstration, and expanded participation in the Bundled Payments for Care Improvement Initiative. Savings from both the Medicare ACOs and Pioneer ACOs exceed $380 million.



2013 in Review: Top 10 Articles from the Center for Health Care Strategies

The Center for Health Care Strategies released this list of their top 10 resources from 2013 on improving health care access and quality for low-income Americans, especially those with complex and high-cost health care needs.



ICRC Releases New Resources To Promote Integrated Care For Medicare-Medicaid Enrollees

ICRC offers a library of Long-Term Services and Supports (LTSS) resources to aid the development of both integrated care initiatives and Medicaid managed LTSS programs. Resources span topics such as provider network development, rate setting, beneficiary assessment tools, and quality measurement.



The President's Committee for People with Intellectual Disabilities (PCPID) Report Now Available in Spanish

This report provides recommendations regarding Managed Long-Term Services and Supports for individuals with intellectual and developmental disabilities. Translation of this document is courtesy of the Puerto Rico UCEDD.



Many Tune into Medicare for Medicaid Advocates Webinar

Nearly 400 people attended the NSCLC Medicare for Medicaid Advocates webinar on July 24, 2013. The free webinar, featuring NSCLC's Directing Attorney Georgia Burke and Medicare Rights Center Director of Education Doug Goggin-Callahan, was targeted to Medicaid advocates whose clients include dual eligibles and low-income older adults. It included not just basic information about Medicare, but also a discussion of Medicare managed care and key differences between the Medicare and Medicaid programs, especially in relation to beneficiary rights and appeals. You can both view and hear the webinar as well as download the power point.



Building State Capacity to Implement Integrated Care Programs for Medicare-Medicaid Enrollees

The success of integrated care initiatives for Medicare-Medicaid enrollees will depend in large part on the skills and knowledge of state Medicaid staff. Expertise in Medicare policy; the ability to conduct robust managed care oversight, data analysis and reporting; and the development of new communication strategies will be critical to program implementation. This technical assistance brief, made possible through support from The SCAN Foundation, examines key areas where states will need to build their internal capacity as they pursue integrated care programs for Medicare-Medicaid enrollees. Focus areas include: basic organizational capacity (leadership, staffing, and knowledge); contract development; data analysis and information systems; stakeholder communication; rate setting; and quality measurement.

pdf File Building State Capacity.pdf [download]


Development of the Financial Alignment Demonstrations for Dual Eligible Beneficiaries: Perspectives from National and State Disability Stakeholders

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As part of the implementation of the Affordable Care Act, 26 states submitted proposals to the Centers for Medicare and Medicaid Services (CMS) to implement demonstrations to integrate care and align financing for beneficiaries who are dually eligible for Medicare and Medicaid; as of July 2013, six states have received approval from CMS to implement a demonstration, and 16 proposals remain pending review. Given the degree of interest in these demonstrations, we sought to identify common issues and potential solutions to inform other states as they develop and implement demonstrations. With an emphasis on illuminating the specific concerns of beneficiaries under age 65 and those who use long-term services and supports, we conducted a series of 26 structured interviews with national and state disability stakeholders from October 2012 through January 2013.

pdf File 8461-development-of-the-financial-alignment.pdf [download]


AARP PPI, NASUAD and HMA Releases a New Report on Long-Term Services and Supports

On July 16th, 2013, AARP Public Policy Institute, National Association of States United for Aging and Disabilities (NASUAD) and Health Management Associates (HMA) released At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint, a new report highlighting the challenges facing states in providing long-term services and supports (LTSS). Even as states begin to implement LTSS options in the Affordable Care Act that increase access to Medicaid home and community based services (HCBS), most states did not increase funding for non-Medicaid services including senior centers, information and referral, transportation and caregiver supports, such as those under the Older Americans Act. The report examines findings of the third annual survey of LTSS systems across 49 states and the District of Columbia, highlighting transformations and reforms underway, and trends across the country. The report found that more states are increasing participation in HCBS options within the Affordable Care Act as well as initiatives for individuals who are dually eligible for Medicaid and Medicare. At the same time, states are seeing increased demand for non-Medicaid services; for example, the caseload for adult protective services for victims of abuse or exploitation has increased in the last two years without increased funding in many states.



Agency Information Collection Activities: Submission for OMB Review; Comment Request

The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, and to allow a second opportunity for public comment on the notice.



KFF's New Issue Brief Compares Six Approved States' Financial Alignment Demonstrations for Dual Eligible Beneficiaries

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KFF recently released an issue brief, Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS. This issue brief compares demonstration programs in California, Illinois, Massachusetts, Ohio, Virginia, and Washington state that will introduce changes in the care delivery systems through which people who are dually eligible for Medicare and Medicaid receive services, as well as changing the payment approach and financing arrangements among the Centers for Medicare and Medicaid Services, the states and providers.



Faces of Dually Eligible Beneficiaries: Profiles of People with Medicare and Medicaid Coverage

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This report illustrates the diverse experiences of dually eligible beneficiaries - low-income seniors and younger adults with disabilities who are eligible for both Medicare and Medicaid - in obtaining medical care and non-medical, supportive services. Based on personal interviews, the profiles of 14 dually eligible beneficiaries residing in California, Florida, Massachusetts, Michigan, and Oklahoma highlight day-to-day experiences with accessing care, maintaining relationships with providers, managing prescription medications and personal finances, and relying on family and friends for additional support. Such personal stories add a human dimension to the ongoing conversations among federal and state policymakers about the importance of high quality, coordinated care for this population.



New Tool for Advocates Addresses Continuity of Care in Duals Demonstrations

New Tool for Advocates Addresses Continuity of Care in Demonstrations Using the five Memorandums of Understanding (MOUs) that have been approved for the dual eligible demonstration projects in Massachusetts, Ohio, Illinois, California and Virginia as a starting point, NSCLC developed a tool for advocates that identifies important elements in a continuity of care policy for states using the financial alignment model. A key protection for dual eligibles is continuity of care. Individuals who join plans participating in dual eligible demonstrations need a smooth transition with no disruption in providers or services while their new plan takes over their care.

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