Consumer protections in Medicare – Medicaid coordinated care models SNP Executive roundtable March 30, 2015 Lynda Flowers Senior Strategic Policy Advisor AARP Public Policy Institute

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DISCUSSION OUTLINE Who are the dual eligibles? Common goals of coordinated care models How dual eligibles benefit from coordinating Medicare and Medicaid AARP policy on coordinated models of care AARP’s policies on essential consumer protections across models AARP activities in the area Looking forward

Who Are the Dual Eligibles? Almost 10 million of the poorest and sickest of all Medicare beneficiaries A population with multiple chronic conditions Require a mix of medical, long-term care, behavioral health and social services

Common Goals of Coordinated Care Models - Care Coordination - Person/family-centered - Aims to keep people in the community - Reduces financial incentives to cost shift - Improves quality of care Program of All-Inclusive Care for the Elderly (PACE) Fully-Integrated Dual Eligible Special Needs Plans Financial Alignment (Duals Demonstrations) Capitated Model

Benefits of Coordinating Medicare and Medicaid Benefits Better outcomes across care settings Reduced avoidable hospitalizations Reduced use of nursing facility care Improved consumer experience of care

AARP’s Position on Integrated Care for Duals AARP sees value in and supports efforts to use all available models to coordinate care for older adults and people with physical and/or cognitive disabilities as long as robust consumer protections are in place.

Consumer Protections: Consumer Facing 1 Consumer freedom-of-choice Independent, conflict free counseling to support choice Continuity of care for new enrollees Smooth transitions Initial and periodic assessments Inclusion of engaged family caregiver(s) in assessments, care planning, and care delivery

Consumer Protections: Consumer Facing 2 Conflict-free care planning Opportunities for self-directed care Care coordination across settings Cultural competence/language access across the experience

Consumer Protections: Consumer Facing: 3 Harmonized consumer protections that provide the most consumer-friendly options (grievance and appeals, timelines, etc.) Access to independent ombudsman Protections from inappropriate cost sharing and balance billing

Consumer Protections: Provider Focused Transparency Plan Readiness Selective contracting based on performance Payment structures that support the delivery of high value, high quality care Sufficient oversight capacity at state and federal levels Robust performance assessments and program evaluation

What is AARP Doing?

What is AARP Doing?

Going Forward AARP is willing to exchange ideas with interested parties on how to improve coordinated care for duals, especially consumer protections. AARP is especially interested in the development of quality measures that assess the special needs of this population (LTSS, care transition, care coordination, etc.). AARP is interested in learning more about how plans that provide coordinated care are providing language access across acute and LTSS settings.

Going Forward AARP is interested in learning more about how high performing plans achieve optimal health outcomes despite serving low socioeconomic populations. AARP is interested in learning more about how plans are addressing the issue of social determinants of health among duals enrolled in coordinated plans.

Related Reports Integrating Medicare and Medicaid: State Experience with Dual Eligible Medicare Advantage Special Needs Plans: http://assets.aarp.org/rgcenter/ppi/health-care/2009_14_maplans.pdf Experienced Voices: What Do Dual Eligibles Want from their Care? Insights from Focus Groups with Older Adults Enrolled in Bothe Medicare and Medicaid: http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/2011/dual-eligibles-12-2011.pdf Keeping Watch: Building State Capacity to Oversee Medicaid Managed Long-Term Services and Supports: http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/keeping-watch-building-state-capacity-to-oversee-medicaid-managed-ltss-AARP-ppi-health.pdf Ready, Set, Go! The Readiness Review Process for Care Coordination and Provider Network Adequacy in Five States: http://www.aarp.org/health/medicare-insurance/info-12-2013/the-readiness-review-process-AARP-ppi-ltc.html

QUESTIONS AND DISCUSSION

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