The Medicare-Medicaid Financial Alignment Initiative Overview and Status Update Lindsay Barnette Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services November 3, 2016

Medicare-Medicaid Enrollee Delivery System Transformation Current State Future State Provider and Payor-Centered Person-Centered Fragmented Care Coordinated Care Volume-Driven Outcome-Driven Complicated Benefit Overlap Simplified Processes 2

About the Medicare-Medicaid Coordination Office 3

Medicare-Medicaid Coordination Office Section 2602 of the Affordable Care Act Purpose: Improve quality, reduce costs, and improve the experience for individuals who receive Medicare and Medicaid benefits. Ensure full access to services to which they are entitled Improve coordination between the federal government and states Develop innovative care coordination and integration models Eliminate financial misalignments that lead to poor quality and cost shifting 4

Medicare-Medicaid Coordination Office Vision: Promote an improved experience for persons with both Medicare and Medicaid by: Focusing on person-centered models that promote coordination Developing a more easily navigable and simplified system of services Ensuring individual access to needed services and incorporating individual protections into each aspect of the new demonstrations Establishing accountability for outcomes across Medicare and Medicaid Requiring robust network adequacy standards for both Medicare and Medicaid Evaluating data on access, outcomes, and individual experience to ensure individuals receive higher quality, more cost-effective care 5

Overview of the Financial Alignment Initiative (FAI) 6

Financial Alignment Initiative Background: A longstanding barrier to coordinating care for Medicare-Medicaid enrollees is the financial misalignment between Medicare and Medicaid In 2011, CMS announced new models to integrate the service delivery and financing of both Medicare and Medicaid through federal-state demonstrations to better serve the population Goal: Increase access to quality, seamlessly integrated services for Medicare- Medicaid enrollees 7

Financial Alignment Initiative FAI Demonstration Models: Capitated Model: Three-way contracts among states, CMS, and health plans to provide comprehensive, coordinated care in a more cost- effective way Managed Fee-for-Service (FFS) Model: Agreements between states and CMS under which states would be eligible to benefit from savings resulting from initiatives to reduce costs in both Medicaid and Medicare Alternative Model: Agreement to integrate care for Medicare-Medicaid enrollees building on the State’s current infrastructure (MN) 8

The Capitated Model Enrollment assistance and options counseling Integrated set of enrollee materials and single ID card Person-centered care planning Choice of plans and providers Minimum travel and distance times Limitations on wait and appointment times Continuity of care provisions Care coordination and assistance with care transitions Integrated grievances and appeals process Substantive participating provider training requirements 9

Current Status of the FAI 10

FAI Participating States WA OR WY UT TX SD OK ND NM NV NE MT LA KS ID HI CO CA AR AZ AK WI WV VA TN SC OH NC MO MS MN MI KY IA IN IL GA FL AL VT PA NY* NJ NH MA ME CT DE RI MD DC Capitated financial alignment demonstration (10 states) Administrative alignment demonstration (1 state) Managed FFS financial alignment demonstration (2 states) *CMS and NY operate two separate capitated demonstrations, both in the NYC area. 11

FAI Participating States Demonstration Name Start Date Washington* HealthPathWashington July 2013 Massachusetts One Care October 2013 Illinois Medicare-Medicaid Alignment Initiative March 2014 California Cal MediConnect April 2014 Virginia Commonwealth Coordinated Care Ohio MyCare Ohio May 2014 Colorado* Accountable Care Collaborative September 2014 New York Fully Integrated Duals Advantage (FIDA) January 2015 South Carolina Healthy Connections Prime February 2015 Michigan MI Health Link March 2015 Texas Texas Dual Eligible Integrated Care Project FIDA Intellectual and Developmental Disabilities (IDD) April 2016 Rhode Island Rhode Island Integrated Care Initiative July 2016 *WA and CO are operating Managed FFS model demonstrations. All other states are operating Capitated model demonstrations. 12

FAI Independent Evaluation CMS contracted with RTI International to evaluate the demonstrations under the Financial Alignment Initiative The mixed methods evaluation includes qualitative components (e.g. site visits, beneficiary focus groups) and quantitative components (e.g. analyses on measures of quality, utilization, access to care, and costs) The first annual evaluation reports for Washington and Massachusetts were recently released An issue brief with early implementation findings from the first seven demonstrations is also available 13

FAI Lessons Learned Positive momentum Dramatic increase in the number of Medicare-Medicaid beneficiaries in financially integrated or total cost-of-care models Hundreds of thousands of assessments, increasing every day Major investments in new care coordination infrastructure Lessons learned Communications and enrollment Provider outreach and engagement Earning beneficiary engagement Unmet need Success stories 14

More Information www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and- Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/ MMCOCapsModel@cms.hhs.gov 15