Title

Financial Alignment Initiative Massachusetts One Care: Third Evaluation Report

Document Type

Article

Publication Date

4-2019

Keywords

Medicare, Medicaid, dual eligible, behavioral health, integrated care, integrated financing, managed care, long term services and supports

Abstract

The Medicare-Medicaid Coordination Office and the Innovation Center at the Centers for Medicare & Medicaid Services (CMS) have created the Medicare-Medicaid Financial Alignment Initiative to test, in partnerships with States, integrated care models for Medicare-Medicaid enrollees. The demonstration in Massachusetts, known as One Care, was implemented October 1, 2013. Three health plans were competitively selected by the Commonwealth and CMS to operate Medicare-Medicaid Plans (MMPs), but one health plan withdrew from participation in the demonstration as of September 30, 2015. One MMP operates in nine counties, with partial coverage in one county; the second MMP operates in three counties, with partial coverage in one county. MMPs provide care coordination and flexible benefits under a capitated payment model. CMS and the Commonwealth provide payments to finance all Medicare and Medicaid services.

This Third Evaluation Report for the Massachusetts One Care demonstration describes the demonstration’s implementation and early analysis of its impacts. The report includes findings from qualitative data for 2017 and quantitative results for October 1, 2013, through December 31, 2016. Data sources include key informant interviews, beneficiary focus groups, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results, Medicare claims data, the Minimum Data Set nursing facility assessments, MMP encounter data for Medicare and Medicaid services, and other demonstration data. Future analyses also will include Medicaid claims and encounters as those data become available.

Comments

This project was funded by the Centers for Medicare & Medicaid Services under contract no. HHSM-500-2014-00037i TO #7. The statements contained in this report are solely those of the authors and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. RTI assumes responsibility for the accuracy and completeness of the information contained in this report.

Funding Organization or Grant

CMS Contract No. HHSM-500-2014-00037i TO#7

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