MassHealth Demonstration to Integrate Care
for Dual Eligibles: Member Focus Groups and
Stakeholder Engagement
Alliance for Health Reform Congressional Briefing
Washington, D.C.
December 12, 2011
Corrinne Altman Moore, M.P.A.
MassHealth/Executive Office of Health and Human Services
Commonwealth of Massachusetts
Initiative to Integrate Care for Dual
Eligible Individuals
■ One of 15 states awarded a $1M planning contract from
CMS Center for Medicare and Medicaid Innovation to
support the development of a design proposal for a State
Demonstration to Integrate Care for Dual Eligible
Individuals
■ Purpose is to identify, support and evaluate personcentered models that integrate the full range of acute,
behavioral health, and long term supports and services
■ Target population: 115,000 dual eligibles ages 21-64 with
full MassHealth and Medicare benefits
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Proposed Benefit Design
■ Medicare Services: All Part A, Part B, and Part D services
■ Medicaid State Plan Services
■ Additional Behavioral Health Diversionary Services
■ Additional Community Support Services
■ Integrated Care Management
– Medical and non-medical services coordinated through multidisciplinary care teams
– Members play an active role in care planning and decisions
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Proposed Delivery Model
■ Integrated care organization (ICO) baseline requirements:
– Foundation of person-centered medical homes, with core
competencies in team-based care, care coordination
– Highly developed acute, primary care, behavioral health, and long
term services and supports provider networks
– Health information technology
■ Global payment for all MassHealth and Medicare services
for acute and primary care, behavioral health and
community support services
■ Contracted ICOs must demonstrate experience and
competencies in serving individuals with disabilities,
chronic behavioral health diagnoses, and chronic medical
problems
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Stakeholder Involvement
■ Regular consumer-focused meetings (7 to date) since March 2010
■ Open public meetings (3 to date) in Boston and Worcester, with robust
participation
■ Member focus groups (4, randomly selected)
■ Public presentation of data analysis on the profile of dual eligibles age 21-64,
sponsored by MMPI
■ Outreach to disability community and advocacy groups, such as:
– Potter Place Clubhouse
– Massachusetts Advocates Standing Strong (MASS)
– Disability Advocates Advancing our Healthcare Rights (DAAHR)
– M-Power
– The Transformation Center
– Boston Health Care for the Homeless Program
■ Public facing website and email address
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Focus Groups Conducted in
Summer 2011
■ Four focus groups of dual eligible members ages 21-64
convened to discuss current benefits and the idea of an
integrated model
■ Rich variation in geography, urban vs. rural location, and
primary language
■ Valuable perspectives and input, including positive
comments about some current benefits and areas that
need improvement
■ Results have been summarized and presented to
stakeholders, and are being considered in our design
decisions
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Focus Groups: Positive Impressions
and Opportunities from Health Care
Experiences
Working Well:
Opportunities:
■ Primary and specialty care
■ Dental services/ Eyeglasses
■ Hospital services
■ Medical transportation
■ PCA Services
■ Low out-of-pocket cost
■ Range of covered services
■ Mailings and materials
■ Customer service
■ Annual eligibility reviews
■ Durable Medical Equipment
(DME) quality and
compatibility
■ Limits on physical therapy
■ Limits on covered
medications
■ Case management
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Focus Groups: Integrated Care
Model
Positive Change:
To Make it Attractive:
■ Eliminate waste; redundancy
■ Include current providers
■ Save money on duplicative
administrative costs
■ Reduce bureaucratic overlap
■ Increase information sharing
between two agencies
■ Level cost-sharing for Rx
■ Ensure continuity of care
■ Include all current benefits
■ Make accessing services
simple
■ Member control over care
decisions
■ Improve dental, eyeglasses,
DME, care coordination
■ Inform members about
change
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Demonstration Features Developed
from Focus Groups, Stakeholder
Feedback
■ Benefit Design:
– Improve current benefits: Dental Services, Eyeglasses, DME
– Add key benefits: Peer supports, nutrition and wellness, community
health workers
■ Enrollment Process and Outreach:
– Neutral/impartial enrollment broker
– Sufficient time and clear information to make a choice
■ Provider Networks:
– Preserve connections to current providers and caregivers
– Require entities to continually enroll providers that meet network
requirements
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Visit us at www.mass.gov/masshealth/duals
Email us at Duals@state.ma.us
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