Title

Financial Alignment Initiative Annual Report: One Care: MassHealth plus Medicare

Document Type

Report

Publication Date

9-2016

Keywords

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

Abstract

The Medicare-Medicaid Coordination Office (MMCO) and the Innovation Center at the Centers for Medicare & Medicaid Services (CMS) have created the Financial Alignment Initiative to test, in partnerships with States, integrated care models for Medicare-Medicaid enrollees. The goal of these demonstrations is to develop person-centered care delivery models integrating the full range of medical, behavioral health, and long-term services and supports (LTSS) for Medicare-Medicaid enrollees, with the expectation that integrated delivery models would address the current challenges associated with the lack of coordination of Medicare and Medicaid benefits, financing, and incentives.

This report analyzes implementation of the Massachusetts capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative, called One Care: MassHealth plus Medicare (hereafter referred to as One Care) from its initiation on October 1, 2013 through the conclusion of Demonstration Year 1 on December 31, 2014. Specifically, this report describes the Massachusetts One Care 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, as well as information on financing and payment. Data sources include key informant interviews, focus groups, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, plan-reported data submitted to CMS’ implementation contractor, and other demonstration data. This report also includes data on the beneficiaries eligible and enrolled, geographic areas covered, and status of the participating Medicare-Medicaid Plans (hereafter referred to as One Care plans or MMPs). Then, it reports results on service utilization and results of targeted analyses related to enrollees, LTSS users, users of behavioral health services and special populations. Finally it presents data on various quality measures.

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