Beneficiary Experience: Early Findings from Focus Groups with Enrollees Participating in the Financial Alignment Initiative

Ptaszek A, Chepaitis A, Green A, Hoover S, Khatutsky G, Lyda-McDonald B, Roberts Q, Thach N, Gattine E, Holladay S, Tranfaglia J
Publication Year: 2017
Patient Need Addressed: Behavioral health, Care Coordination/Management, Long-term services and supports
Population Focus: Complex care, Dual eligible
Intervention Type: Service redesign
Study Design: Other Study Design
Type of Literature: Grey
link: https://innovation.cms.gov/Files/reports/fai-focusgroup-issuebrief.pdf
Abstract

This Issue Brief describes the results of focus groups conducted in six States as part of the Centers for Medicare & Medicaid Services Financial Alignment Initiative to test integrated care and financing models for Medicare-Medicaid enrollees. Five of these States—California, Illinois, Massachusetts, Ohio, and Virginia—are implementing a capitated model demonstration in which Medicare-Medicaid Plans (MMPs) provide coordinated benefits and access to new and flexible services through a person-centered care model. One, Washington, is implementing a managed fee-for-service model demonstration in which health homes are responsible for organizing enhanced integration of primary, acute, behavioral, and long-term services and supports across existing delivery systems for Medicare-Medicaid enrollees and for directing person-centered care for high-cost, high-risk enrollees.

Insights Results

Successes

  • Overall, participants’ satisfaction with the demonstration varied by State and across
    focus groups, and was influenced by their experience with the benefits and services they used as well as ease of access and cost
  • Some participants observed that the under the demonstration it became easier to navigate the system to obtain needed services, and the cost of these services had decreased
    Challenges
  • Participants’ awareness of the ability to opt out of the demonstrations or change plans throughout the year varied. Some were aware of this option, but others believed they needed to wait for the next enrollment period to make a change
  • Participants were confused by changes in enrollment and coverage without their knowledge or consent. They also had complaints about the limitations of the provider networks
  • Across all of the focus groups, participants reported that the written materials they received were often dense, difficult to understand, and presented an overwhelming amount of material
  • Some participants with limited English proficiency were unaware that translated materials were available
  • Participants had mixed experiences with access to care, with some participants describing increased access to new or flexible services including home-based services and supports, home modifications, and counseling, which had positive impacts on their quality of life
    • NEW SEARCH