Karen Kimsey, Deputy Director, Complex Care & Services Virginia Department of Medical Assistance Services National Association of Medicaid Directors

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1 Karen Kimsey, Deputy Director, Complex Care & Services Virginia Department of Medical Assistance Services National Association of Medicaid Directors November 3, 2015

2 Commonwealth Coordinated Care Is Integrated Demonstration program blending Medicare & Medicaid into one program utilizing managed care plans Goal: improve health outcomes through more coordinated care Benefits: One system, one card, care coordination, expanded benefits Participating Partners CMS!! Anthem Humana VA Premier Population Full Duals 21 & older Live in one of 5 CCC region: 102 participating urban and rural localities Includes: EDCD & NF Excludes: Hospice; Other comprehensive insurance; Other LTSS Waiver Status First effective enrollment phased in regionally Apr Nov Continue to automatically assign newly eligible beneficiaries Beneficiaries may opt-in/opt-out at any time September Enrollment: 29, 176 Virginians

3 Automatic Assignment Localities: April

4 CCC Current Enrollment 12,000 Enrollment By Region and Type 10,000 8,000 6,000 4,000 EDCD Waiver (10%) Nursing Facility (13%) Community Well (77%) 2,000 - Total Enrollment as of 9/5/15 = 29,176 4

5 CCC Current Enrollment CCC Enrollment By Plan and Region* Central Virginia Northern Virginia Roanoke Tide Water Western/ Charlottesville Grand Total Virginia Premier 2, ,233 1, ,154 Anthem HealthKeepers 3,698 1,729 1,812 3,783 1,236 12,258 Humana 3,218 1,585 2,042 3, ,764 Total 9,575 3,368 5,087 8,371 2,775 29,176 *Enrollment Data for September 2015 Enrollment data is posted regularly to the Stakeholder Updates portion of DMAS CCC webpage: /altc-stkhld.aspx 5

6 VA s Successes Contract Monitoring: Created weekly dashboard for relevant startup issues (HRAs, claims, appeals, etc) to quickly identify potential concerns National leader in HRA completion rates First state to do the in depth on-site compliance review with our EQRO (HSAG). Next steps: deliver findings reports and state will closely follow Corrective Action Plans to track and monitor 6

7 IT: VA s Successes Continued First created a manual process to handle unsolicited enrollment transactions. Now this is a partially automated process, and we continue to refine. VA recognized as developing best practice for: Creating a companion guide for the MTR Transparent/collaborative engagement with MMPs through weekly Operations call to discuss enrollment, MTR, and CAP payment discrepancies. System changes are well received by MMPs because the decisions were transparent and collaborative 7

8 VA s Challenges Enrollment: No lock-in period creates policy challenges and increases opportunity for enrollment discrepancies Coordinating two large enrollment systems for a single program leads to a high volume of communications between systems, needing continuous management When discrepancies occur, retroactive changes made to two systems is significantly more disruptive than just to one system Provider Buy-in: Providers strongly influence beneficiary participation (experienced mass opt-out attempts) Large systems choosing not to participate 8

9 VA s Challenges Continued Communicating with beneficiaries: Letters didn t resonate with beneficiaries. Not only messaging but getting the message to the beneficiary (bad addresses, people not reading mail) MMPs understanding LTSS: The social model of care is less familiar. The mechanism of care in consumer direction is new for MMPs Continuity of care: Back and forth from MMP, to FFS, etc. Challenges to ensure no disruption of service/difficult for the provider 9

10 Next Steps for CCC Formalizing contract monitoring plan for remaining two years Addressing opt-outs through the Annual Letter Focusing on improving process and systems: Revision of the year two reporting requirements Modified to now report quarterly. This enables quick response and early interventions if needed. Focusing on enrollee experience: Engaging enrollee to share their experience through focus groups, observations, George Mason survey, and exploring member decision making process of opting out through enrollment broker Merged enrollee satisfaction and quality of life survey to reduce survey fatigue 10

11 Next Steps for VA VA General Assembly mandate to bring Medicaid populations under managed care CCC will sunset as originally scheduled, December 2017 Coordinating care for Duals through MLTSS and DSNPs. 11