MassHealth Demonstration to Integrate Care for Dual Eligibles

One Care: MassHealth plus Medicare

Implementation Council Meeting – MassHealth Update

February 28, 2014,11:00 AM – 1:00 PM

1 Ashburton Place, 21st Floor

Boston, MA

Total Enrollment

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■ Effective February 1, total number of enrollees: 9,541

Total Enrollment by PlanCommonwealth Care Alliance (CCA) 6,238Fallon Total Care (FTC) 2,503Network Health 800

Total 9,541

■ Total number of opt-outs as of February 1: 16,642■ Additional details regarding enrollment as of February 1 are

posted in the Monthly Enrollment Report on the One Care website

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Round Two Auto-Assignment Update

■ Round two auto-assignments will take effect April 1, 2014

■ Approximately 6,400 people are being automatically enrolled in a One Care plan for an April 1 start date

■ MassHealth mailed 60-day notices to those individuals on January 24-25, and 30-day reminder notices on February 21

■ Round two includes individuals from across the target population, including those with higher levels of LTSS and behavioral health need (i.e., C1, C2 and C3 rating categories)

■ In addition to primary care, MassHealth used data on where individuals accessed LTSS and behavioral health services to match individuals to a One Care plan

■ MassHealth worked closely with the One Care plans throughout the assignment process to understand their capacity to accept additional auto-assignment enrollments, and to maximize matches with their provider networks

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Auto-Assignment and Medicare Part D■ Both the 60-day and 30-day notice mailings included an insert on

“One Care and Part D” to help members understand what auto-assignment in One Care means for their Part D coverage, including:– You will continue to receive your prescription drug benefits from

your current plan through March 31, 2014 – Your new prescription coverage from the One Care plan will start

on April 1

■ This is to address concerns that members are receiving notices from their Part D plans about being disenrolled

■ To provide additional information to members, MassHealth is working with CMS to develop more comprehensive information about Part D coverage and One Care– Will address enrollment, continuity of care, covered drugs, and

other key topics– MassHealth will also work with SHINE, which has expertise in

helping individuals understand Medicare Part D and their options

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LTS Coordinator

■ MassHealth is continuing efforts to ensure that we have an effective Independent Living and Long Term Services and Support (LTS) Coordinator role in One Care

■ MassHealth is working with stakeholders, the Implementation Council, and the One Care plans to– Develop a common understanding of, and vision for, the role of the

LTS Coordinator– Achieve balance in implementation such that the LTS Coordinator

resources meet the actual needs of One Care members (numbers and skill sets); adds value; and is fiscally responsible

– Determine approaches for communicating the value, role and availability of an LTS Coordinator to enrollees and members

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LTS Coordinator (cont’d)■ Out of these dialogues, specific action steps are being identified; so

far, these include:– Developing standard language/materials for members that explains

the LTS Coordinator and the option for members to have one on their Care Team

– Designing training protocols for providers and plans on how the LTS Coordinator role will be implemented in One Care

■ Implementation Council will be represented in the ongoing dialogue, along with DAAHR, ILCs, RLCs, ASAPs, the One Care plans, the One Care Ombudsman, and EOHHS/MassHealth

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Assessment Data

■ MassHealth has begun working with the plans to collect information on assessment including the following:– Number of assessments completed– Number of LTS Coordinator referrals– Number of LTS Coordinator encounters

■ Along with other early indicators, this data will give us a sense of how implementation is going with regard to the assessment process and the use of LTS Coordinators

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Mailing to Additional Members

■ In September 2013, MassHealth sent a One Care Enrollment Package to approximately 82,000 members and their guardians– Introduced One Care and let members know about the

opportunity to self-select into a One Care plan in their area– Included a One Care Enrollment Guide, a cover letter with a

purple stripe, a List of Covered Services, and an Enrollment Decision Form

■ MassHealth is now planning to send a similar mailing, in late March, to:– Individuals who have become eligible for One Care since

September mail file was created– Others who appear eligible in MassHealth data, but were not

mailed to in September■ Expected to include approximately 10,000-15,000 members in total■ MassHealth will look at feedback and experience with September

mailing to make improvements for March mailing

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Consumer Outreach Strategies

■ Focused on increasing public awareness of One Care with efforts at the community level, including– Scheduling sessions/events with community organizations that

work with One Care target populations (e.g. ILCs, RLCs, organizations focused on homelessness)

– Briefing legislators on One Care and identifying opportunities and/or venues in their districts for targeted outreach

■ Targeting 3-6 community sessions over the next 6 months

■ These efforts will be informed by outreach Implementation Council members and others have been doing with their community contacts

Provider Engagement Strategies

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■ Targeted outreach to key providers (April/May 2014)– Planning event to bring influential providers into conversation about

advantages of participating in One Care – Targeting primary care in particular, which is key in member

enrollment decisions– Scheduling for April/May

■ Communication with members and providers (Ongoing)– Developing provider facing materials (FAQ, Provider Guide, Flyer)

to communicate with providers about One Care– One Care member materials assure members they can change

their mind about enrollment at any time– Encouraging plans to continue provider network development;

strategically focus on large provider groups

■ Coordinate with the Implementation Council Provider Strategy workgroup

MassHealth and Implementation Council Planning Meeting

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■ MassHealth is coordinating with the Implementation Council chairs to set up a meeting within the next few weeks

■ Key agenda items will be:– 2013 Implementation Council Annual Report– 2014 work plan– 2014 priorities

Visit us at www.mass.gov/masshealth/onecare

Email us at OneCare@state.ma.us