Special Populations Enrolled in Demonstrations Under the Financial Alignment Initiative

Abstract

This Issue Brief provides an update on the beneficiary experience in the first two demonstrations that were implemented as part of the Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative to test integrated care and financing models for Medicare Medicaid enrollees. The Washington Health Homes MFFS demonstration, a managed fee-for service model demonstration, and the Massachusetts One Care demonstration, a capitated model demonstration, began operations on July 1st and October 1st of 2013, respectively. For the purposes of this report, special populations encompass the following: (1) enrollees who use long-term services and supports (LTSS) which include nursing facilities, personal care services, residential care facilities, and adult day care; (2) enrollees with Behavioral healths, including those with serious and persistent mental illness (SPMI) such as schizophrenia and bipolar disorder; and (3) linguistic, ethnic, and racial minorities enrolled in the demonstrations. The purpose of this brief is to report how enrollees who use these services are faring under the Washington and Massachusetts demonstrations and to understand if disparities in services and demonstration experiences exist for these groups.

Insights Results

Challenges

In both States, some focus group participants still struggled—as they did prior to the demonstration—to access specialty services and some focus group participants experienced additional struggles with communicating across providers

In Washington, some focus group participants had trouble differentiating their care coordinators from service-specific case managers who have more limited responsibilities. Massachusetts participants also noted that it was confusing to sometimes have multiple care coordinators, particularly during the initial assessment; they noted lack of follow-up with services that had been identified during the initial assessment, but not provided

Several focus group participants in both States said they experienced difficulties getting wheelchairs or wheelchair repairs; some said that they had not sought help from their care coordinators
Care Outcomes

Some focus group participants reported improvements in their health and quality of life since enrolling in the demonstration

Washington focus group participants were more likely to achieve their goals by working with their care coordinator to change their own behavior rather than by accessing additional services. Goals included managing diabetes, quitting smoking, losing weight, maintaining ambulation, and increasing community engagement. Massachusetts focus group participants generally related their improved quality of life to new or additional services provided by the demonstration

Many focus group participants with long-term services and supports (LTSS) and Behavioral healths described improvements in their health or quality of life in the past year, including increased physical functioning and reduced social isolation