UPDATE ON THE IMPLEMENTATION OF CALIFORNIA S COORDINATED CARE INITIATIVE Eileen Kunz Chief of Government Affairs & Compliance On Lok Carol Hubbard Executive Director of Home & Community Services St. Paul s PACE October 2015 1
LEARNING OBJECTIVES Provide overview of California s Coordinated Care Initiative Highlight key issues of concern for PACE and how CalPACE and PACE organizations have worked together to address concerns Describe what two PACE organizations have done to be successful in the changing environment 2
COORDINATED CARE INITIATIVE Coordinated Care Initiative (CCI) was enacted in 2012 to better coordinate care for Medi-Cal beneficiaries CCI has two parts: Cal MediConnect (CMC) (formerly called the Dual Demonstration) is a three-year voluntary demonstration for beneficiaries with full Medicare and Medi-Cal Excludes duals who are Regional Center clients, in certain waiver programs, beneficiaries with ESRD and beneficiaries with a share of cost in the community Managed Long Term Services and Supports (MLTSS) All Medi-Cal beneficiaries, including duals, are required to join a Medi-Cal managed care plan to receive Medi-Cal benefits including long-term services and supports (IHSS, CBAS, MSSP and nursing facility care) and Medicare wrap around benefits 3
COORDINATED CARE INITIATIVE COUNTIES San Mateo Alameda Santa Clara San Bernardino Los Angeles Riverside Orange San Diego Map Source: Calduals.org 4
OVERLAP OF CA DUALS DEMO WITH PACE County Cal MediConnect Plans PACE Plan(s) Alameda* Alameda Alliance Anthem Blue Cross Center for Elders Independence On Lok Lifeways Los Angeles Care1st, CareMore, Health Net, LA Care & Molina Health AltaMed PACE Brandman Centers for Senior Care Orange CalOptima CalOptima PACE Riverside Inland Empire Health Plan & Molina Health InnovAge Greater CA PACE San Bernardino Inland Empire Health Plan & Molina Health InnovAge Greater CA PACE San Diego Care1st, Community Health Group, Health Net & Molina Health St. Paul s PACE San Diego PACE San Mateo Health Plan of San Mateo Santa Clara Anthem Blue Cross & Santa Clara Family Health Plan On Lok Lifeways * In November 2014, DHCS announced Alameda County will not move forward with CCI. 5
COORDINATED CARE INITIATIVE CCI originally authorized in eight counties with seven counties moving forward implementation based on readiness: San Mateo County (April 2014) Riverside, San Bernardino and San Diego Counties (May 2014) Los Angeles County (July 2014) Santa Clara County (MLTSS July 2014 and CMC January 2015) Orange County (August 2015) For most beneficiaries, enrollment is based on birth month with 90, 60 and 30 day notices before passive enrollment Large enrollment wave occurred in January 2015 Passive enrollment ends after one year 6
CAL MEDICONNECT ENROLLMENT OPTIONS* Opt In Dual (subject to passive enrollment) Choose Cal MediConnect Plan FFS Medicare Choose Medi Cal Plan Medicare Advantage Assigned to Medi Cal Plan PACE Assessment Enrolled in PACE if Eligible Opt Out Request PACE Do Nothing Enrolled into Cal MediConnect Plan A beneficiary can disenroll from Cal MediConnect or change plans at anytime for any reason. The disenrollment is effective the first day of the next month. *Adapted from NSCLC presentation www.nsclc.org 7
Cal MediConnect Choice Form Choose a Cal MediConnect Plan: Fill out Option A ONLY To Opt Out of Cal MediConnect, fill out Option B ONLY. If you are already in a Medi Cal plan, Choose the Medi Cal plan you are already in To choose PACE, fill out PACE bubble and EITHER A or B as a backup 8 8
CAL MEDICONNECT ENROLLMENT 9
CAL MEDICONNECT ENROLLMENT 10
EXPERIENCE TO DATE Enrollment lower than projected in Cal MediConnect (CMC) As of July 2015 CMC Disenrolled 24% Opted Out 44% Enrolled 32% Enrolled Opted Out Disenrolled 11
EXPERIENCE TO DATE Erroneous enrollment notices Enrollment notices going to individuals excluded form CMC Enrollment notices going to individuals exempt from passive enrollment Confusion about enrollment notices Incorrect addresses and phone numbers High rates of unable to contact impact beneficiaries and ability of health plans to conduct health risk assessments Confusion about continuity of care requirements High Opt-out rates particularly among some ethnic groups Providers actively encouraging beneficiaries to opt-out 12
CAL MEDICONNECT OPT-OUTS 13
CAL MEDICONNECT OPT-OUTS 14
EARLY IMPLEMENTATION CONCERNS for PACE Concern about impact of passive enrollment on PACE referrals and enrollment Pressure on PACE organizations to contract with health plans to maintain viability Possible elimination of PACE as a separate program
PACE PROTECTION PROVISIONS California PACE Association Advocacy Current PACE participants exempt from passive and mandatory enrollment in health plans PACE is an enrollment option and included in all outreach materials PACE organizations have 60 days to assess beneficiaries who select PACE before they are assigned to plans No enrollment lock-ins 16
PACE EXPERIENCE Greater visibility of PACE organizations CalDual.org website Outreach and Enrollment Materials including choice form
To choose PACE, fill out PACE bubble and EITHER A or B as a backup
PACE EXPERIENCE Greater visibility of PACE organizations Participation in Stakeholder meetings Advisory Boards Justice in Aging education and advocacy
PACE EXPERIENCE Low enrollment through DHCS process Unable to contact many candidates Many are not PACE eligible Doctor and IHSS preference
ALL PACE ENROLLMENT THROUGH CMC PROCESS AS OF 7/31/2015 2% Enrolled 14% Enrolled In Process Declined 34% Unable to contact 12% 37% Declined Ineligible Unable to Contact In Process Ineligible
PACE ENROLLMENT THROUGH CMC PROCESS AS OF 7/31/2015 Enrolled 2% 2% 7% All PACE Declined 37% 45% On Lok Unable to contact 25% 34% 37% 54% St. Paul's PACE Denied 12% 28% 2%
PACE PROGRAM OUTCOMES AS OF 7/31/2015 Lower than expected referrals: 1780 Lower than expected direct enrollments: 44 Unable to contact: 34%
PACE EXPERIENCE Recognition of PACE as a proven model Referral arrangements for PACE enrollment approved by DHCS Partnering with Plans to provide services to Plan members Competition for enrollments
PACE EXPERIENCE PACE viewed as a participating Health Plan Opportunities for Input Shared Challenges with Plans DHCS Support DHCS Goals for Alignment with Plans - Quality and Outcomes data - Encounter reporting - Rate setting formulas
PACE EXPERIENCE PACE viewed by Plans as a Service Provider PACE referrals Contract with Plans
PACE EXPERIENCE Confirmation of uniqueness of PACE All Inclusive vs. Network Coordination Challenges
PACE CENSUS GROWTH IN CCI COUNTIES 2000 1800 1600 1400 1200 1000 800 600 400 200 0 AltaMed On Lok St. Paul's Brandman CalOptima InnovAge San Diego Jan-14 Jul-14 Jan-15 Jul-15
CALIFORNIA PACE ENROLLMENT 6000 5000 4716 5040 5221 4000 4156 3629 3000 2642 2894 2000 1000 0 Dec-10 Dec-11 Dec-12 Dec-13 Dec-14 May-15 Jul-15
WHAT S AHEAD High opt-out rates causing concern for the viability of Cal MediConnect State budget set January 2016 for evaluation of costeffectiveness or CCI will cease to operate by January 2017 State has submitted non-binding letter to extend the demo CCI has highlighted need for housing resources to enable beneficiaries to remain in community or transition back into community Evaluation and additional legislation is required to expand the number of counties
WHAT S AHEAD Continued opportunities for PACE program growth Health Plan Referral Contracted Services Diversified Internal Outreach
QUESTIONS?