Integrating Care for Individuals Eligible for Medicare and Medicaid Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services June.

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Presentation transcript:

Integrating Care for Individuals Eligible for Medicare and Medicaid Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services June 2011

Medicare-Medicaid Beneficiaries Account for Disproportionate Shares of Spending Total Medicare Population, 2006: 43 Million Total Medicare FFS Spending, 2006: $299 Billion Total Medicaid Population, 2007: 58 Million Total Medicaid Spending, 2007:$311 Billion Dual Eligibles as a Share of the Medicare Population and Medicare FFS Spending, 2006: Dual Eligibles as a Share of the Medicaid Population and Medicaid Spending, 2007: Kaiser Family Foundation, The Role of Medicare for the People Dually Eligible for Medicare and Medicaid, January

Medicare-Medicaid Coordination Office Section 2602 of the Affordable Care Act (ACA) Purpose: Improve quality, reduce costs, and improve the beneficiary experience. –Ensure dually eligible individuals have full access to the services to which they are entitled. –Improve the 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. 3

Medicare-Medicaid Coordination Office Major Areas of Work The Medicare-Medicaid Coordination Office is working on a variety of initiatives to improve access, coordination and cost of care for Medicare-Medicaid enrollees in the following areas: Program Alignment Data and Analytics Models and Demonstrations Other 4

Program Alignment Pursue opportunities to better align Medicare and Medicaid requirements to advance seamless care for Medicare-Medicaid enrollees. Develop overarching plan to measure quality for Medicare-Medicaid enrollees. Coordinate within CMS and across HHS for efforts to address issues impacting Medicare- Medicaid enrollees. 5

Medicare-Medicaid Coordination Office Alignment Initiative Initiative to identify and address conflicting requirements between two programs that are potential barriers to seamless and cost effective care. Seeking input in six areas: 1. Coordinated Care4. Cost Sharing 2. Fee-for-Service benefits (FFS)5. Enrollment 3. Prescription Drugs6. Appeals List of alignment opportunities for public comment through July 11 th : coordination/Downloads/FederalRegisterNoticeforComment pdfhttp:// coordination/Downloads/FederalRegisterNoticeforComment pdf

Data and Analytics Create national and state profiles of dual eligibles. Analyze impact of eligibility pathways to better understand beneficiary experience. Improve state access to Medicare data for care coordination, including timely availability of A, B and D data. – 5/11/2011 Informational Bulletin available at: inated-Care-Info-Bulletin.pdf inated-Care-Info-Bulletin.pdf Leverage other CMS initiatives to analyze dual population (e.g. geographic variation and potentially avoidable hospitalizations) 7

Models and Demonstrations Partnership with the Innovation Center to test delivery system and payment reform that improves the quality, coordination, and cost-effectiveness of care for dual eligible individuals. 15 states selected receive up to $1million to design new models for serving dual eligibles (CA, CO, CT, MA, MI, MN, NY, NC, OK, OR, SC, TN, VT, WA, WI). Planning underway for future projects that could include a focus on nursing facilities, health homes, and Special Needs Plans (SNPs). 8

Medicare-Medicaid Coordination Office Other Initiatives Beneficiary focus groups Listening sessions Technical assistance for states, plans and providers Ongoing stakeholder engagement Consultation with MedPAC and MACPAC 9

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