1. http://www.dmas.virginia.gov/ 1 Department of Medical Assistance Services December 1, 2015 Gerald Craver, PhD Mathew Behrens, MPA Sarah Broughton, MSW Beth Rafferty, LCSW http://www.dmas.virginia.gov 1 Department of Medical Assistance Services Review of Commonwealth Coordinated Care Beneficiary Focus Groups (CY 2015)

2. http://www.dmas.virginia.gov/ 2 Department of Medical Assistance Services Overview Focus Group Study Overview Participant Recruiting, Discussion Questions, Data Collection, and Analysis CCC Enrollee Participant Demographics CY 2015 Focus Group Findings Study Limitations Next Steps Questions, Comments, or Concerns

3. http://www.dmas.virginia.gov/ 3 Department of Medical Assistance Services Focus Group Study Overview Purpose is to examine the impact of CCC on dual eligible beneficiaries with behavioral health (BH) needs and to identify areas for program improvement Implemented using plan developed by the evaluation team and reviewed by the evaluation advisory committee and other stakeholders ( http://www.dmas.virginia.gov/Content_pgs/ ccc-eval.aspx )

4. http://www.dmas.virginia.gov/ 4 Department of Medical Assistance Services Recruiting Strategy and Discussion Questions Partnered with Virginia Association of Community Services Boards (VaCSB) to recruit CCC enrollees meeting certain criteria –receiving psycho-social services from one of 3 CSBs assisting with project (1 in Tidewater and 2 in Central Regions) –enrolled in CCC for at least 3 months and familiarity with program services –capable of communicating experiences in a group setting Discussion questions covered CCC enrollment, program experience, care coordination, and areas for improvement

5. http://www.dmas.virginia.gov/ 5 Department of Medical Assistance Services Data Collection and Analysis 3 focus groups consisting of 22 participants (19 beneficiaries and 3 family members/caregivers representing beneficiaries) –Informed consent obtained prior to data collection Because of confidentiality issues, discussions were not audio recorded. Instead, the evaluation team prepared detailed notes on the discussions –Validity assessed using multiple evaluators, participant review, and internal review by evaluation team members to ensure intercoder-reliability Data analyzed using constant comparison method

6. http://www.dmas.virginia.gov/ 6 Department of Medical Assistance Services CCC Enrollee Participant Demographics DemographicsFrequency (N=22) GenderFemale (10), Male (12) CCC EnrolleeYes (22) Enhanced Care CoordinationYes (22) a AgeAvg. (53.8 yrs.), Rng. (29-71 yrs.) EDCD Waiver ParticipantYes (1), No (19), Unknown (2) Mobility ImpairmentYes (4), No (18) Health Risk Assessment (HRA)Yes (8), No (3), Unknown (11) b Plan of Care (POC)Yes (7), No (4), Unknown (11) b Interdisciplinary Care Team (ICT)Yes (3), No (8), Unknown (11) b Note: Based on data collected by the CSB staff on the 22 CCC enrollees recruited to participant in the focus groups. a Enhanced Care Coordination is an integrated primary care/behavioral health service designed to meet the needs of CCC enrollees with serious mental illness and/or intellectual disabilities and serious/chronic medical conditions. b Staff at one CSB were unable to determine if the same 11 participants had received HRAs, POCs, or ICTs.

7. http://www.dmas.virginia.gov/ 7 Department of Medical Assistance Services CY 2015 Focus Group Results 5 major themes identified describing impact of CCC on enrollees with BH needs and identifying areas for program improvement –Learning about CCC through Notification Letters and/or CSB staff –Improving Medical Care and Physician Communication –Interacting with Medicare-Medicaid (MMP) staff –Desiring to Continue CCC Participation –Improving CCC by Eliminating Medical Bill Summaries and Offering Denture Coverage

8. http://www.dmas.virginia.gov/ 8 Department of Medical Assistance Services CY 2015 Focus Group Results (Continued) Learning about CCC through Notification Letters and/or CSB staff –Participants reported receiving CCC notification letters and/or having conversations with CSB case managers about enrolling in the CCC Program –Participants also reported working with CSB case managers to enroll in CCC Improving Medical Care and Physician Communication –Participants reported receiving additional benefits (e.g., vision, hearing, ECC, and home visits) after CCC enrollment –Participants also reported communication among physicians based on signing release/consent forms and getting referrals

9. http://www.dmas.virginia.gov/ 9 Department of Medical Assistance Services CY 2015 Focus Group Results (Continued) Interacting with MMP staff –Participants reported communicating with MMP staff through periodic phone calls and home visits to discuss extra benefits, Medicaid eligibility, pain management, exercise, etc. Desiring to Continue CCC Participation –All participants expressed desire to continue participating in the CCC Program Improving CCC by Eliminating Medical Bill Summaries and Offering Denture Coverage –Participants reported confusion/stress when receiving medical bill summaries and recommended eliminating them –Participants also reported need for denture coverage and recommended including it as an extra CCC benefit

10. http://www.dmas.virginia.gov/ 10 Department of Medical Assistance Services Limitations of Focus Group Study Findings limited to 3 focus groups in two demonstration regions composed of a non- random sample of CCC enrollees with BH needs –Thus, the results do not necessarily generalize to all CCC enrollees with BH needs Findings may be limited because they are based on subjective participant impressions that may be biased due to recall limitations

11. http://www.dmas.virginia.gov/ 11 Department of Medical Assistance Services Next Steps Continue conducting in-depth interviews of beneficiaries, care coordinators, and providers to collect information for CCC evaluation Prepare short case studies briefly illustrating the experiences of specific beneficiaries, care coordinators, and providers Continue observing care coordination activities to report on processes used to support beneficiaries in community and institutional settings

12. http://www.dmas.virginia.gov/ 12 Department of Medical Assistance Services Questions, Comments, or Concerns For additional information on the CCC Evaluation, please contact: –Gerald Craver gerald.craver@dmas.virginia.gov 804-786-1754 gerald.craver@dmas.virginia.gov –Or visit the CCC Evaluation website http://www.dmas.virginia.gov/ Content_pgs/ccc-eval.aspx