On May 31, the R.I. Executive Office of Health and Human Services submitted a demonstration proposal to the Center for Medicare and Medicaid Services for how to manage the dual-eligible population for Medicare and Medicaid in Rhode Island.
The proposed program seeks to achieve a coordinated approach through a new system of managed, integrated care, with both improved care and cost-savings. It also has significant future state budget ramifications in reducing the state’s Medicaid budget.
Today, nearly half of the entire Rhode Island Medicaid budget is spent on the dual eligible population, although they make up less than a quarter – 38,000, or 21 percent – of the total 180,000 Medicaid enrollees in Rhode Island.
One of the key people who will be working on this program is Dr. Deidre S. Gifford, medical director at the Executive Office of Health and Human Services. She was the former director of the Rhode Island Chronic Care Sustainability Initiative, an organization at the forefront of the effort to develop patient-centered medical homes in Rhode Island
PBN: What progress has been made in developing an integrated state policy and strategy to deliver health care to the dual eligible populations for Medicaid and Medicare?
GIFFORD: Individuals who qualify for both Medicare and Medicaid benefits (the so-called “dual eligible” population) represent a very important population for Rhode Island’s Medicaid program. These individuals tend to have significant medical and behavioral health needs, and because of that are frequent users of the health care delivery system.
It is vitally important that their care is coordinated, and integrated with the community-based services and supports they need to ensure they receive the most appropriate and timely care possible.
To address this issue, the Executive Office of Health and Human Services and Medicaid Agency have developed two documents that describe our proposed approach to care coordination and integration for these individuals.
The first is a report to the general assembly, and the second is a proposal to the Centers for Medicare and Medicaid Services. [Both documents are available at www.ohhs.ri.gov/integratedcare/index.php]
PBN: What are the next steps to implement the new strategic direction?
GIFFORD: Our proposal envisions a two-phase process. In the first phase Medicaid services and care coordination are consolidated into either an enhanced fee-for-service strategy, or a managed care program in 2013. In 2014, if the proposal to CMS is accepted and implemented, both Medicare and Medicaid services would be combined into a managed care program for this population. The fee-for-service option developed in 2013 would also remain available.
In the mean time, R.I. Medicaid continues to incorporate the input of local stakeholders in to the development of our programs.
PBN: How important was the policy makers breakfast in November 2011, hosted by Neighborhood Health Plan of Rhode Island, in setting the table to move this effort forward?
GIFFORD: The input of stakeholders into the development of this program is a critical component in insuring that the program meets the complex needs of this population.
We are sensitive to the need to ensure robust care coordination among primary care providers, home- and community-based services, long-term care facilities and hospitals. Coordinating these sometimes-fragmented segments of the delivery system will be the cornerstone of a successful program.
PBN: How does the new strategy fit within the growing efforts to establish patient centered medical homes as the best way to organize the delivery of health care in Rhode Island?
GIFFORD: Robust, high-quality primary care is an essential component of care delivery for individuals with chronic disease. Evidence shows that increased use of primary care is associated with both lower costs and better health outcomes.
Our programs will be designed to ensure that individuals have access to primary care services that are coordinated with the other community-based and long-term care services that represent a significant portion of the care needs for this particular population.
PBN: How will the projected budget savings for this new strategy be able to be reinvested into the delivery care system?
GIFFORD: We believe this program will help to ensure that dually eligible individuals receive the best possible primary and preventive care, that they are connected to home and community-based services that can help them remain independent in the community, and that their chronic diseases are optimally managed.
These benefits are not only meant to produce the best health outcomes for our members, but also to provide care in the most efficient and effective settings possible.
When fully implemented, this program has the potential to improve both the quality and efficiency of Medicaid and Medicare services to a vulnerable and important population.
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