A Seat at the Table: Consumer Engagement in the Dual Eligible Demonstration Projects Renee Markus Hodin, JD Director, Integrated Care Advocacy Project May 2, 2013 2013 American Geriatrics Society Annual Scientific Meeting Grapevine, Texas
About Community Catalyst Nonprofit health care advocacy organization Network of advocates in 40+ states Building advocacy infrastructure Leading broad-based issue campaigns © 2013
Consumer Engagement: Design The Impact The Demand Consumer Engagement: Design The Impact Consumer Engagement: Implementation © 2013
The Demand © 2013
Expectation of Consumer Involvement “Medicare-Medicaid enrollees, their families and consumer organizations working with them… have a central role to play in helping to design a person-centered system of care….CMS encourages and expects active and meaningful State engagement with stakeholders in both models.” ~ State Medicaid Director letter on Financial Alignment Initiative July 11, 2011 © 2013
Expectation of Consumer Involvement “Collaboration with consumer and consumer advocacy groups is critical. In order to achieve the important goals of better health and better care with lowered costs, we must continue to put our beneficiaries first. This is a time of significant change in the Medicaid program, and we should ensure beneficiaries’ voices are heard in the design, implementation, and oversight of new initiatives.” ~ State Medicaid Director letter on Integrated Care Models July 10, 2012 © 2013
The Key © 2013
Consumer Engagement: Design © 2013
Consumer Priorities Enrollment Beneficiary Protections Provider Networks Long-Term Services and Supports Coordination Benefits Consumer Engagement Beneficiary Protections Adequacy of Payment/Savings Expectations Quality Measurement Cultural Competence © 2013
Coalition Aging Cross-disability Physical Behavioral health Substance use disorder Legal services Medicaid defense © 2013
Grassroots Open meetings/educational sessions Individual stories Hearing testimony Meetings with policymakers © 2013
Policy Analysis Hearing testimony Formal comments State Federal © 2013
Communications © 2013
Allies Geriatric providers LTSS providers AAAs Health plans Medical homes © 2013
Policymakers Hearing testimony Formal comments State Federal Workgroups Advisory teams © 2013
The Impact © 2013
Impact Size, scope, timing Reductions in population size Shift from statewide to regional Delay in start-up date © 2013
Impact Enrollment Benefits No Medicare lock-in Vision Dental Voluntary enrollment period Enrollment counseling Benefits Vision Dental Non-emergency transportation Behavioral health diversionary services © 2013
Impact Care Coordination Oversight Contracts with LTSS referral/service providers IL-LTSS Coordinator Oversight State-level oversight committee Delivery system committees Ombudsman © 2013
Impact Consumer Protections Continuity of care Grievances and appeals Aid pending appeal Improved notices Cultural Competence Increased emphasis on provider and staff compliance with the ADA Training requirements for independent living and recovering learning philosophies © 2013
Consumer Engagement: Implementation © 2013
Consumer Priorities Enrollment Beneficiary Protections Provider Networks Long-Term Services and Supports Coordination Benefits Consumer Engagement Beneficiary Protections Adequacy of Payment/Savings Expectations Quality Measurement Cultural Competence © 2013
The Key © 2013
Consumers Geriatric Providers Collaboration Union of Policy and Practice Consumers Geriatric Providers © 2013
Collaboration Inform/participate in advocacy efforts Convey views to larger public Advance evidence-based models of care Depression screening and treatment Transitions Self-management programs Promote the use of appropriate quality measures Oversight Promote role for geriatric providers © 2013
Voices for Better Health Advance policies that require coordinated, patient-centered care that allows dually eligible older adults to have a better quality of life Establish a strong voice for dually eligible older adults and caregivers in the health plans and provider groups that serve them © 2013
Director, Integrated Care Advocacy Project Renee Markus Hodin, JD Director, Integrated Care Advocacy Project Community Catalyst rmhodin@communitycatalyst.org 617.275.2810 © 2013