Challenges and Opportunities: Entering the SNP and DSNP Market
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1 Challenges and Opportunities: Entering the SNP and DSNP Market Ghita Worcester SVP, Public Affairs & Chief Marketing Officer National Medicare Advantage Summit April 6,
2 UCare Independent, not-for-profit Minnesota health plan. Rooted in primary care. Strong consumer focus. 634 employees. 160,503 members. *5/1/17 Projected membership 324,500
3 SNP and DSNP Timeline 1997 Minnesota Senior Health Options (MSHO) 2001 UCare Complete FIDESNP today UCare Connect UCare Connect + Medicare
4 MSHO Timeline RWJF Grants: $230,000; 1995: $2.1M 1995: CMS approved MN waiver for integrated Medicare/ Medicaid Demo for : MSHO demo begins, named Demonstration to Align Administrative Systems for Improvements in Beneficiary Experience. 2001: UCare and MN- DHS work to implement Medicare/Medicaid Demo for people with disabilities Services included MN disability waiver services (2020?): MSHO Dual Demo via MN-CMS MOU.
5 MSHO Demographics (March 2017) Enrollment 11,608 members 34% non-metro Ethnicity 40% non-white Caucasian Age 23% (65-69) 22% (70-74) 18% (75-79) 14% (80-84) 23% (85+) Gender 68% Female Living Status 38% Community Well 16% Institution 46% NHC/Waiver
6 MSHO Features MOU signed by state and CMS (vs. 3-way contract). Two federal waivers: Appeals timelines. Joint state/federal material review in HPMS. State-CMS Contract Management Team. Clarified authority for integrated enrollment, materials development, etc. Annual joint CMS-State network review.
7 MSHO Features One CAHPS (Consumer Assessment of Health Plan Satisfaction) survey for MSHO enrollees. State permitted to add questions to Medicare survey. State allows Medicare Quality Improvement Program (QIP) to meet state Performance Improvement Project (PIP) requirement. Health Outcomes Survey (HOS) developed in Somali. Modest grant funding to state for staff, evaluation, reporting, dual data base, materials, outreach.
8 Improvements in Care HHS report highlights the effectiveness of the MSHO program by comparing similar beneficiaries inside and outside of the program. MSHO enrollees compared to FFS: 48% less likely to have an IP stay. 6% less likely to have an OP ER visit. 13% more likely to receive home and community based long-term care services.
9 UCare Connect + Medicare Fully integrated Medicare and Medicaid coverage for dualeligible SNBC enrollees. Offered in 11 Minnesota counties.
10 MSHO and Connect + Medicare Member Benefits One card for medical, dental, and prescription drug coverage. One customer service number. Less billing confusion for member, doctor, and pharmacist. One Care Coordinator/Care Navigator. Mobile Dental Clinic provides expanded dental access. Emphasis on health and wellness. Member-centered care model.
11 Requirements for Entering Market Champions at state, plans, providers, etc. Dedicated state team. Get all stakeholders on the same page. Ongoing stakeholder engagement - consumers, providers, advocates. Collaboration, information sharing between health plans, state, CMS, providers, advocates. Patience
12 Challenges In absence of permanent authority, will we have to unwind MSHO in the future? Ongoing need to address situations where Medicare Advantage guidance conflicts with integrated processes. Ensuring auditors understand demonstration features. Includes people across subsets - community, community frail and institutional (so not eligible for frailty factor b/c community frail not isolated). Need Medicaid managed care products that feed SNPs across service areas.
13 Challenges Potential for misalignment of timing of state, health plan strategic initiatives. States and plans need to work together. Example: November CY 2016: Health plan required to submit Notice of Intent to Apply (NOIA) to CMS as placeholder for CY 2018 (new, expansion). February - June 2017: Health plan required to submit CMS application/bid for CY 2018 offering. March - Apr 2017: Typical MN procurement results for CY 2018.
14 Opportunities Build relationships with stakeholders consumers, advocates, community organizations, providers, counties, other health plans, state and federal legislators, state and federal regulators, industry, etc. Take/support the long view It takes time for relationships to develop, ideas to gel, change the way things are. States/plans need to dedicate resources to study/focus/work on integration (e.g., comments to CMS, collaborate with state, across plans).
15 Thank you 15
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