Title

Financial Alignment Initiative Massachusetts One Care: Second Evaluation Report

Document Type

Report

Publication Date

4-2019

Keywords

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

Abstract

This Second Evaluation Report on the Massachusetts capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative, called One Care, is one of several reports that will be prepared over the coming years to evaluate the demonstration. The Centers for Medicare & Medicaid Services (CMS) contracted with RTI International to monitor the implementation of the demonstrations under the Financial Alignment Initiative, and to evaluate their impact on beneficiary experience, quality, utilization, and cost. This report uses a variety of data sources to analyze One Care’s impact. It provides qualitative updates on the implementation of the demonstration for the second and third demonstration years (calendar years [CYs] 2015 and 2016), with relevant updates through early 2017. The report describes the demonstration’s key features; the policies, administrative processes, and strategies the State adopted as it implemented the demonstration; and successes achieved and challenges encountered. Specifically, this report addresses the demonstration’s approach to integrating the Medicare and Medicaid programs; providing care coordination to enrollees; enrolling beneficiaries into the demonstration; and engaging stakeholders in the oversight of the demonstration. We also provide impact analyses using enrollment and encounter/claims data, analyses of service utilization patterns and quality metrics using both predemonstration and demonstration periods from October 1, 2011 to December 31, 2015. We also provide a summary of preliminary findings related to Medicare savings results through the second demonstration year, January 1, 2015 through December 31, 2015 (therein, demonstration year 2). Demonstration year 3 refers to the January 2016 through December 2016 timeframe.

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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