Submitted by clevine on Thu, 06/07/2012 – 2:02pm
If we can fix health care for people with complex health conditions, we can fix health care for everybody. That’s why everyone who thinks we need a better health care system needs to be paying attention to Ohio’s efforts to create a demonstration project to integrate care for people… (READ MORE)
who are on both Medicaid and Medicare. For the national perspective, see Drew Altman’s column for Kaiser Family Foundation and Community Catalyst’s Dual Eligible Demonstration Projects:
Top Ten Priorities for Consumer Advocates with added materials to come on the UHCAN Ohio website (www.uhcanohio.org).
Folks who are on Medicare and Medicaid have something in common – they have low incomes and few assets. They also receive coverage from two very different programs that were not built to work together and lead people to suffer from fragmented care and unmet needs, and avoidable stays in nursing homes and hospitals. But the dually eligible are also a very diverse group of people. They include people over 65 and younger adults with disabilities. Their needs for medical and long term care services vary widely, as do their personal health and life goals. Among them are some of the highest users of health and long term care services. Thus, people who are dually eligible are the target of national and Ohio efforts to transform their care.
Ohio’s Office of Health Transformation has proposed a demonstration project that will improve the patient experience and health outcomes, while reducing wasteful spending. They are to be commended for an ambitious effort to improve care and coordination for people with complex needs. But they are trying to move way too fast. The most successful integrated care programs for people who are dually eligible – such as PACE (Program for All-Inclusive Care for the Elderly) – have relatively low numbers of enrollees. If any state knew how to provide coordinated care to dually eligible people on a large scale, they would have done so long ago.
Status of Ohio’s Proposal:
Ohio submitted a proposal to the Center for Medicaid and Medicare Services (CMS) of the federal government on April 2, 2012. Ohio proposes to enroll almost 115,000 Ohioans, in 7 regions, in new “Integrated Care Delivery System (ICDS)” plans, on a mandatory basis, over the course of a few months in early 2013. These ICDS plans will be traditional Managed Care Plans, most of which have little to no experience with these populations. (Note: The Wall Street Journal reports on money to be made from the “duals” market: “Dual patients, who represent a potential $300 billion market for health insurers, have become a hot topic as states and the federal government look for ways to better coordinate care and save money.”
The public comment period to CMMS closed on May 2, 2012. CMS is now having conversations with Ohio about how to proceed. We hope CMMS will agree with advocates in Ohio and across the nation that states should slow down and make enrollment voluntary, at least during the first year, while we work out the bugs.
On Tuesday, June 5, 2012, at a news conference announcing their new initiative to expedite Medicaid eligibility for pregnant women and children, Medicaid Director John McCarthy explained why they were launching the pilot in only a few sites: “The worse thing we can do is to roll it out with bugs in it and people don’t get the services they need.” If this is true for expediting Medicaid eligibility for pregnant women and children, this certainly is true for older adults with multiple chronic health conditions and people with disabilities who need assistance with daily living activities.
Let’s hope that Ohio decides – or the feds decide for Ohio – that the duals demonstration needs to start slowly – with people enrolling voluntarily based on the expectation of improved care.