Some states iffy on ex­tend­ing ‘du­als’ demo

Modern Healthcare - - NEWS - By Vir­gil Dick­son

This sum­mer the Obama ad­min­is­tra­tion con­ceded it needs more time to eval­u­ate a large-scale test co­or­di­nat­ing ben­e­fits and care for low-in­come and dis­abled Amer­i­cans. The par­tic­i­pat­ing states ap­pear will­ing to stick with it, although the two big­gest ones ex­pressed sig­nif­i­cant reser­va­tions.

Twelve states have rolled out three-year demon­stra­tions un­der the Af­ford­able Care Act to bet­ter align the health ben­e­fits of Amer­i­cans who are el­i­gi­ble for both Medi­care and Med­i­caid, and as a re­sult, re­ceive splin­tered care at ex­tremely high costs to both pro­grams.

In spite of wide­spread chal­lenges, all of those states sig­naled they’re in­ter­ested in the ad­min­is­tra­tion’s in­vi­ta­tion to ex­tend their pro­grams for two years be­yond the time they were sched­uled to end. States en­rolled at dif­fer­ent times; Mas­sachusetts was the first, and its demo is set to ex­pire Dec. 31, 2016, un­less ex­tended.

The CMS said in a re­cent let­ter to Med­i­caid di­rec­tors that the ex­tra time would min­i­mize dis­rup­tions for ben­e­fi­cia­ries and al­low RTI In­ter­na­tional, the re­search firm hired to eval­u­ate the demos, more time to col­lect and an­a­lyze data.

“The long-term vi­a­bil­ity of the mod­els we are cur­rently test­ing de­pends on whether we are able to mea­sure im­prove­ments in qual­ity and over­all cost sav­ings,” the CMS said in the let­ter. The states took the let­ter as a vote of con­fi­dence from Washington, said Matt Salo, ex­ec­u­tive di­rec­tor of the Na­tional As­so­ci­a­tion of Med­i­caid Di­rec­tors.

Pol­icy ex­perts and pa­tient ad­vo­cates say pa­tients en­rolled in the pro­gram are pleased with the care they’re get­ting. “I have not heard any­one in any form crit­i­cize this care model,” said Stephanie An­thony of con­sult­ing firm Manatt Health So­lu­tions. An­thony ad­vised Mas­sachusetts when it was form­ing its demo.

But not all of the states are en­thu­si­as­tic about the pro­gram’s fi­nan­cial and ad­min­is­tra­tive struc­ture. Cal­i­for­nia of­fi­cials said they would con­sider, but could not com­mit to an ex­ten­sion, not­ing “chal­lenges that re­quire on­go­ing re­fine­ments to our pro­gram.”

Cal­i­for­nia Gov. Jerry Brown flagged the demon­stra­tion in his an­nual bud­get pro­posal as cost­ing rather than sav­ing the state money, and said if that doesn’t im­prove soon, Cal­i­for­nia will pull out at the start of 2017 when its demo ends. Texas replied to the ad­min­is­tra­tion with a list of is­sues to be ad­dressed be­fore the state ex­tends its par­tic­i­pa­tion.

Cal­i­for­nia and Texas aren’t the only ones run­ning into hur­dles. All 12 par­tic­i­pat­ing states are re­port­ing high rates of ben­e­fi­cia­ries opt­ing out. Of the 1.7 mil­lion peo­ple el­i­gi­ble in the 11 states with fi­nan­cial align­ment demon­stra­tions (Min­nesota’s is lim­ited to ad­min­is­tra­tive func­tions), just 24% had signed up as of Aug. 1, ac­cord­ing to Com­mu­nity Cat­a­lyst, a con­sumer ad­vo­cacy group.

Most of the pro­grams are re­ly­ing on pri­vate health plans to man­age care, and those plans have dropped out in some states. Some in­sur­ers say they’ve had trou­ble get­ting ac­cu­rate con­tact and de­mo­graphic in­for­ma­tion from state agen­cies for ben­e­fi­cia­ries who are pas­sively en­rolled in their plans.

Still, many par­tic­i­pat­ing health plans re­main com­mit­ted to the ef­fort.

“This is a very im­por­tant pro­gram which dras­ti­cally changes how the most vul­ner­a­ble peo­ple in our healthcare sys­tem are cared for,” said Lois Si­mon, pres­i­dent of the Com­mon­wealth Care Al­liance, a plan in Mas­sachusetts rec­og­nized as a pi­o­neer in co­or­di­nat­ing care for dual-el­i­gi­ble pa­tients. “We feel five years is a more ap­pro­pri­ate timeline to see its full po­ten­tial.”

“This is a very im­por­tant pro­gram which dras­ti­cally changes how the most vul­ner­a­ble peo­ple in our healthcare sys­tem are cared for.”

Lois Si­mon Pres­i­dent Com­mon­wealth Care Al­liance

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