Metropolitan Health Plan - Long Term Quality Alliance

About the
Association for
Community Affiliated Plans
September 2014
ACAP’s Mission
To represent and strengthen not-for-profit
safety net health plans as they work with
providers and caregivers in their
communities to improve the health and
well-being of vulnerable populations in a
cost-effective manner.
ACAP Represents 58 Safety Net Health Plans
University of Arizona Health Plans
Alameda Alliance for Health
CenCal Health
Central California Alliance for Health
Community Health Group
Contra Costa Health Plan
Gold Coast Health Plan
Health Plan of San Joaquin
Health Plan of San Mateo
Inland Empire Health Plan
Kern Family Health Care
L.A. Care Health Plan
Partnership HealthPlan of California
Santa Clara Family Health Plan
San Francisco Health Plan
Colorado Access
Denver Health
Community Health Network of Connecticut
District of Columbia
Health Services for Children With Special Needs
Prestige Health Choice
Family Health Network
Passport Health Plan
Maryland Community Health System
Priority Partners
Boston Medical Center HealthNet Plan
Commonwealth Care Alliance
Neighborhood Health Plan
Network Health
ACAP Represents 58 Safety Net Health Plans
Metropolitan Health Plan
New Hampshire
Well Sense Health Plan
New Jersey
Horizon NJ Health
New York
Affinity Health Plan
Amida Care
Elderplan & Homefirst
Hudson Health Plan
Monroe Plan for Medical Care, Inc.
Univera Community Health
AmeriHealth Caritas Pennsylvania
UPMC for You
Rhode Island
Neighborhood Health Plan of Rhode Island
Children’s Medical Center Health Plan*
Community Health Choice
Cook Children’s Health Plan
Driscoll Health Plan
El Paso First Health Plans
Sendero Health Plan
Texas Children’s Health Plan
Virginia Premier
Community Health Plan of Washington
Children’s Community Health Plan
*Incubator plan.
ACAP’s 58 Plans are in 24 States
23 ACAP Plans Operate SNPs
Affinity Health Plan (N.Y.)
Alameda Alliance for Health (Calif.)*
AlohaCare (Hawaii)
AmidaCare (N.Y.)
CalOptima (Calif.)
CareOregon (Ore.)
CareSource (Ohio)*
Colorado Access (Colo.)
Commonwealth Care Alliance (Mass.)
Community Care Alliance of Illinois/FHN
• Community Health Group (Calif.)
• Community Health Plan (Wash.)
• Denver Health Medical Plan (Colo.)
• Elderplan & Homefirst (N.Y.)
• GuildNet (N.Y.)
• Health Plan of San Mateo (Calif.)
• Inland Empire Health Plan (Calif.)
• L.A. Care Health Plan (Calif.)
• Metropolitan Health Plan (Minn.)*
• Partnership HealthPlan of California*
• University of Arizona Health Plan**
• UPMC for You (Pa.)
• VNSNY CHOICE Health Plans (N.Y.)
* Operating SNP through 2014.
** Entering SNP market in 2015.
17 ACAP MLTC Plans
Affinity Health Plan (N.Y.)
Alameda Alliance for Health (Calif.)
Amida Care (N.Y.)
CalOptima (Calif.)
Commonwealth Care Alliance (Mass.)
Community Health Group (Calif.)
Elderplan & Homefirst (N.Y.)
Guildnet (N.Y.)
Health Plan of San Mateo (Calif.)
Horizon NJ Health
Inland Empire Health Plan (Calif.)
L.A. Care Health Plan (Calif.)
Metropolitan Health Plan (Minn.)
Neighborhood Health Plan of R.I.
Santa Clara Family Health Plan (Calif.)
VillageCareMAX (N.Y.)
VNSNY CHOICE Health Plans (N.Y.)
17 ACAP Plans Planning or
Participating in Duals Demos
 California: Alameda Alliance for Health*; CalOptima*; Community
Health Group of San Diego; Health Plan of San Mateo; Inland
Empire Health Plan; L.A. Care; Santa Clara Family Health Plan*.
 Massachusetts: Commonwealth Care Alliance; Network Health
 Minnesota (D-SNP Model): Metropolitan Health Plan***
 New York: Elderplan/HomeFirst, GuildNet, VillageCareMAX,
VNSNY Choice Health Plans
 Ohio: CareSource
 Rhode Island: Neighborhood Health Plan of R.I.**
 Virginia: Virginia Premier Health Plan
Other ACAP plans are in non-demo duals initiatives
* Delayed
** LTC services began Nov. 2013; Medicare services included in 2015
*** MHP leaving MSHO demo in 1/15
Mary Kennedy | Vice President |Medicare and Managed Long Term Care
Association for Community Affiliated Plans
1015 15th St. NW Suite 950 | Washington, DC 20005
Direct: (202) 701-4749
1015 15th St. NW, Suite 950
Washington, DC 20005
[email protected]
Minnesota Senior
Health Options
Sue Kvendru
Minnesota Department of
Human Services
Minnesota Experience
Medicaid Managed Care since 1985
Minnesota Senior Health Options since 1997
Initially Medicare Payment Demo
D-SNP ( Initial MOU with CMS to transition)
MOU with CMS for Alternative Demo signed
September, 2013 – Not a Financial Alignment
Demo (FAD)
Minnesota Senior Health Options (MSHO)
Combines Medicare (including Part D) and Medicaid
Includes Elderly Waiver (MLTSS)
Includes 180 days of nursing home care
Enrollment is voluntary instead of mandatory
enrollment in Medicaid Managed Care program
70% have chosen to enroll in MSHO
Approximately 36,000 enrolled
Operating statewide
All eight MSC+ (Medicaid managed care) plans
MSHO Features: Overview
Integrated member materials, one enrollment form, aligned
enrollment dates, one card for all services
State MLTSS assessment tool integrates Health Risk Assessment
(HRA into assessment process
All members are assigned individual care coordinators. The State
sets uniform standards, audit protocols and criteria for care plans,
face to face assessment and care coordination
Flexible care coordination delivery models
High degree of collaboration among SNPs and State on member
materials, PIPs, care coordination, benefit policy, demo decisions,
etc. through multiple joint workgroups
Health plans waive Medicaid co-pays for members
State level Stakeholders group, each SNP also has local
stakeholders group.
Aligned capitated financing supports innovation and payment
Minnesota Demonstration
“Demonstration to Align Administrative Systems
for Improvement in Beneficiary Experience”
Charts a new demo option path for improving
States’ ability to work with Medicare Advantage
Dual-Eligible Special Needs Plans (D-SNPs)
Builds on current D-SNPs
Current SNP and Medicaid financing and rates
• HEDIS: 98% of MSHO seniors have annual primary care visits
• Dual database: MSHO risk adjusted hospital admits/episode rates lower than
FFS Medicare Medicare Advantage (Source: JEN iMMRS-MN)
• S&Ps and STARS: MSHO D-SNPs have been high performing on STARS and
SNP S&P measures
• CAHPS: MSHO is highest rated MN Medicaid program; includes care coordination
• Disenrollment rates: < 2%
• Encounter data analysis: Increased HCBS access through annual face to
face assessment/individualized care coordination
• AARP scorecard: MN has been #1 for HCBS Access.
– Minnesota has rebalanced its MLTSS system from 63% NF and 9.5% community
waivers in 1996 to 24% NF and 39% community waivers in 2012.
– See Rebalancing Graph (Sources: 1996 Medicaid Forecast, July 2012 Medicaid
enrollment by living arrangement).
Contact Info
Sue Kvendru, Managed Care ( Seniors)
[email protected]
Deborah Maruska, Managed Care (People with
[email protected]
Key Attributes of Integrated Health Organizations and
Person-Centered Innovations
September 18, 2014
Sarah Barth, JD
Director of Integrated Health and Long-Term Services
Integrated Care Projects at CHCS
• Implementing New Systems of Integration for Dual Eligibles (INSIDE)
Brings together 16 states for group learning, innovation sharing, and opportunities to work with
federal partners
Supported by The SCAN Foundation and The Commonwealth Fund
• Promoting Integrated Care for Dual Eligibles (PRIDE)
Brings together 7 integrated health organizations to identify and test innovative strategies that
enhance and integrate care for Medicare-Medicaid enrollees
PRIDE consortium membership: CareSource (OH); Commonwealth Care Alliance (MA); Health
Plan of San Mateo (CA); iCare (WI); Together4Health (IL); UCare (MN); VNSNY CHOICE (NY)
Supported by The Commonwealth Fund
• Integrated Care Resource Center (ICRC)
Established by CMS to help states advance integrated care delivery for
Medicare-Medicaid enrollees
Technical assistance and online resources provided by CHCS and Mathematica Policy Research
PRIDE Framework for High-Performing
Integrated Health Plans
 Attributes in 5 Domains:
1. Leadership and Organizational Culture
2. Infrastructure to “Scale Up” and “Stretch Out” While
Maintaining Quality and Value
3. Financial and Nonfinancial Incentives and Related
Mechanisms that Align Plan, Provider, and Member
4. Coordinated Care Provided through Comprehensive,
Accessible Networks and Person/Family-Centered Care
Planning and Coordination
5. Capacity to Attract and Retain Members, Expand
Enrollment, and Increase Retention
Person-Centered PRIDE Projects
360 degree view of
individuals’ care needs
Commonwealth Care
Improving documentation
of care plans for fluidity
and person-centeredness
Health Plan of San
Pilot project providing
supplemental residential
Making assessments
more person-centered
and culturally sensitive
Building independence
through person-centered
planning for PCA services
Making care planning
more person-centered
Addressing social
determinants of health
from the beginning

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