Early Findings on Care Coordination in Capitated Medicare-Medicaid Plans Under the Financial Alignment Initiative

Green A
Publication Year: 2017
Patient Need Addressed: Care Coordination/Management
Population Focus: Dual eligible
Intervention Type: Service redesign
Type of Literature: Grey

This Issue Brief provides an update on the status of care coordination activities and early findings on successes and challenges of providing care coordination services for the nine capitated model demonstrations implemented between October 2013 and February 2015 under the Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative to test integrated care and financing models for Medicare-Medicaid enrollees. The information included in this Issue Brief covers the period from the start of each capitated model demonstration through February 2016. The managed fee-for-service model demonstrations under the Financial Alignment Initiative are not addressed in this Issue Brief.

Insights Results

Overview of report

  • Challenges included: implementing the care coordination system, including hiring and training care coordinators in time for serving a large number of passively enrolled Medicare-Medicaid enrollees; lack of understanding of the care coordination benefit by enrollees, and lack of enrollee awareness of care coordinators and how to reach them; and implementing data management systems to support centralized enrollee tracking
  • Requirements on the scope and time frame for completing the Health Risk Assessments (HRAs) varied by state
  • Medicaid Managed Plans (MMPs) in most States had considerable difficulties completing the Institutional Care Program (ICP)s, with only 1 State exceeding 80% of its enrollees and 4 States with completion rates of less than 50%
    Care management
  • Coordinating care for Medicare-Medicaid enrollees with behavioral health needs is especially challenging. Coordination is difficult because of the silos among the medical, long-term support services (LTSS), and behavioral health delivery and financing systems
  • Care coordinators from the MMPs do not operate in an environment devoid of care coordination; in some cases, the new system overlapped and duplicated existing coordination systems, creating tensions and concerns about job security
  • Many MMPs have made substantial progress in building care management information systems and providing access to these systems to providers participating in the care management process. However, some MMPs experienced difficulties in creating a centralized enrollee record that the entire interdisciplinary care team (ICT) can access
  • In terms of implementation, States and MMPs faced several challenges including hiring and retaining large numbers of care coordinators, locating and reaching enrollees, completing the HRAs and ICPs within required time frames, and involving all members of the ICTs, including physicians and Medicare-Medicaid enrollees