The Medicare Payment Advisory Commission (MedPAC) provided a status report presentation on the financial alignment demonstration for dual-eligible beneficiaries (duals).
This is one of the many population health initiatives from the Center for Medicare and Medicaid Services’ (CMS) Innovation Center. The demonstration’s goals are to provide more coordinated care to duals and better align the financial incentives between Medicare and Medicaid. CMS has partnered with 13 states to test two models; a capitated model relying on health plans to administer benefits through the receipt of a blended capitated rate, and a managed fee-for-service model relying on states to provide care coordination between the two programs with the state eligible for a retrospective performance payment if savings are achieved. CMS maintains a website of updates and resources on the Medicaid-Medicare Coordination Office’s site.
Broadly characterized, MedPAC reported that the demonstration is not meeting early expectations with lower than expected enrollment due to trouble identifying and locating enrollees, challenges with providing care for duals with behavioral health conditions, low initial impact on affecting change in service use and utilization patterns, and issues with payment methodology for the Medicare-Medicaid plans in capitated models. The initial three year demonstration period has been given a two year extension to better realize the goals of the program, but Virginia as one participant has already indicated they will be phasing out their participation at the end of the initial period.
We are pleased that several commissioners in their comments emphasized the importance of housing as a health issue as it relates to both locating and coordinating care for individuals with complex medical needs that many duals have. Additionally, it was discussed that better engagement is needed with both potential participants in such a program as well as the provider organizations who have a history with the participants and understand and provide for their care needs. LeadingAge is supportive of the population health goals of this and other demonstrations from the Innovation Center but believe that housing, post-acute, and long-term care providers ought to be active collaborators in the design and administration of the models not merely services to be coordinated. The full transcript of the April meeting including this session can be found on MedPAC’s website.