Massachusetts launches dual eligibles demonstration plan
Massachusetts has finalized a memorandum of understanding with the Centers for Medicare & Medicaid Services (CMS) to test the federal agency's capitated financial alignment model for Medicare-Medicaid dual eligible beneficiaries.
CMS's aim is to streamline and improve what are largely fragmented and costly healthcare delivery systems for often-disabled Americans enrolled in both Medicaid and Medicare. Massachusetts' demonstration plan will focus on dual eligibles from ages 21 to 64 and emphasizes patient relationships with independent living support coordinators and community-based organizations.
[Also: Most dual eligible care still paid for under FFS model]
This will be Massachusetts' first real foray into managed care, according to a Kaiser Family Foundation policy brief. In 2010, 93 percent of dual eligible patients in the state received care through Medicaid fee for service, according to data compiled by Kaiser.
Massachusetts was the first of 26 states to get CMS approval for its demonstration plan, which will begin in April 2013. The state's roughly 111,000 dual eligible beneficiaries ages 21 to 64 will be passively enrolled in the demonstraton plans, but are able to opt out before or after enrollment. People enrolling in the demonstration will be able to receive healthcare through MassHealth (the state's Medicaid program), Medicare and additional behavioral health and community support services aimed at better integrating care.
In June, Massachusetts announced it was seeking applications for Integrated Care Organizations (ICOs) in the demonstration. The ICOs will act as patient-centered medical homes, providing MassHealth and Medicare benefits, behavioral health services, community support and independent living services.
[Also: ACOs have potential for big savings, reduced readmissions]
The ICOs, which haven't been selected yet, will contract with the Massachusetts Department of Health and Human Services and with CMS. Community-based services and independent living counseling will be overseen by "Living-Long Term Services and Support Coordinators" based at community organizations.
The ICOs will receive a global payment from MassHealth and Medicare, allowing some flexibility to coordinate medical and community-based services and help promote independent living, while avoiding potentially unnecessary and costly care.
Annual spending per dual eligible in Massachusetts was around $23,000 in 2009, compared to the national average of $16,000, according to the Kaiser Family Foundation.
"This initiative will help test a new model for improving and simplifying healthcare for individuals enrolled in both Medicare and MassHealth," MassHealth director Julian Harris, MD, said in a media release. "Providers will have flexibility under this integrated system to consider an individual's full needs and unique circumstances and to tailor a care plan to meet them."
