California s Duals Demonstration: A Transparent and Inclusive Stakeholder Process. Peter Harbage President Harbage Consulting

Transcription

1 California s Duals Demonstration: A Transparent and Inclusive Stakeholder Process Peter Harbage President Harbage Consulting 1

2 Today s Agenda 1. California Context 1. California s Stakeholder Engagement Efforts for the Duals Demonstration 1. Stakeholder Communication Toolkit 1. California s Approach to Integrating Care for Dual Eligibles 2

3 California Context 1.1 million dual eligibles 1/3 live in L.A. County 2/3 are 65 and older Roughly 14% of Medi- Cal population ~ 20% enrolled in Medi-Cal managed care 15% & 39% Multiple State Agencies Provide Medicaid-funded services to duals 3

4 Stakeholder Engagement 1. Inclusive 1. Building relationships: Bridging stakeholders & state staff to facilitate two-way communication 2. Open public meetings and open work groups 3. Focus on Accessibility 2. Transparent Share all major announcements & updates with 1,300-person stakeholder list Seek public comment on documents; release redlined version to show changes 4

5 Transparency & Building Trust CA DHCS leadership is fully committed to transparency: posting key documents with red-lined edits after public comment period 5

6 Stakeholder Engagement: Communications Toolkit CalDuals domain & address Easy to remember; easy for consultants to track Constant Contact Manage & segment 1,300 person list; plan meetings and conduct surveys Maestro Conferencing Conduct meetings via phone Adobe Acrobat Make all documents accessible (Section 508 compliant) Social Media Interactive website Twitter 6

7 Keeping Stakeholders Informed 7

8 A portrait of dual eligibles Earsy, 77, is a mother of nine, a grandmother of 27, and greatgrandmother to 13. Earsy is one of 1.1. million dual eligible beneficiaries in California Like 70% of them, she qualifies because she is elderly and has a low income. She has high blood pressure and diabetes, which led to a stroke 12 years ago that left her paralyzed on her right side. She uses a wheelchair and relies on caregivers through the state s IHSS program to assist with activities of daily living, such as getting in and out of bed, bathing, dressing, and meal preparation. 8

9 A portrait of dual eligibles Diane, 59, is a dual eligible beneficiary because of a disabling mental health condition. For years she has struggled with her disability and accessing medical care. She has had long stretches with no access to a psychiatrist. She went four years without seeing a dentist or optometrist. Diane joined a managed care plan with a tailored program for dual eligibles. Through this program, a doctor makes house calls and a social worker helps coordinate her care. 9

10 CA Demonstration Goals 1. Coordinate state and federal benefits and access to care across settings using a person-centered approach. 2. Maximize the ability of dual eligible beneficiaries to remain in their homes and communities. 3. Increase the availability and access to home- and community-based alternatives. 4. Preserve and enhance the ability for consumers to selfdirect their care and receive high quality care. 5. Optimize the use of Medicare, Medi-Cal and other State/County resources. 10

11 Proposed Geography: Counties 4 with Current State Authority Los Angeles (343,000) Health Net and LA Care Orange (74,000) CalOptima San Diego (69,000) Molina, Care 1 st, Community Health Group, Health Net San Mateo (14,000) Health Plan of San Mateo Four proposed, pending further authority: Alameda (42,000) Alameda Alliance & Anthem Blue Cross Santa Clara (46,000) Santa Clara Family Health Plan & Anthem Blue Cross San Bernardino (50,500) Inland Empire Health Plan & Molina Riverside (50,000) Inland Empire Health Plan & Molina 11

12 Proposed Demonstration Model Population 690,000 dual eligibles in 8 counties Most full-benefit dual eligibles No children under age 18 No PACE, AIDS Health Care Foundation Enrollees Enrollment Passive enrollment with a voluntary opt out Six-month stable enrollment period Phased-in throughout 2013 Financing Capitated payment models with 3-way contracts between CMS, CA Department of Health Care Services, and health plans 12

13 Duals Demonstration Pillars 13

14 Vision: Integrated Model of Care Initial Health Risk Assessments Individualized Care Plans Care Coordination Teams Health plans responsible for providing seamless access to a full continuum of services Strong consumer rights Joint state-federal oversight 14

15 Demonstration: Covered Benefits Medicare Part C and D Benefits Medi-Cal Services currently required in managed care coverage Long-term services and supports Coordination with mental health and substance use carved-out programs Supplemental Benefits: Pending rates, health plans intend to offer dental, vision, podiatry care, transportation and possibly some housing alternatives 15

16 What s Next Proposal at CMS for state 30-day public comment period MOU development between State DHCS & CMS Health plan readiness reviews and contracts Public stakeholder workgroups LTSS Integration IHSS Coordination Behavioral health coordination/integration Beneficiary Notifications, Appeals and Protection Quality and Evaluation Fiscal and Rate Setting Provider Outreach March 2013 launch 16

17 Ongoing, meaningful stakeholder involvement At a minimum, the state and health plans will develop a process for gathering ongoing feedback from external stakeholders on program operations, benefits, access to services, adequacy of grievance processes, and other consumer protections. The above definition was created by stakeholders. 17

18 More Information Website: