Making Our Health Care System Work for Older Adults and People With Disabilities John Arnold OCVIC, Project Director x237 Making a difference Together Ohio Chapter of GAPNA's 7th Annual Continuing Education day “Why Your Voice Matters” March 14, 2015

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – The Problem Limited care coordination Fragmented Care Current system is confusing and difficult to navigate Multiple health care needs and high cost The health care and long-term care systems are not connected very well, even though people use both. 2

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – The Need  People with both Medicare and Medicaid are among Ohio’s highest need patients  They are shuttled between multiple doctors who do not communicate with each other or recognize the whole person they are supposed to serve.  As a result, these consumers often suffer from unnecessary tests, contradictory therapies and ineffective treatment. 3

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Dually Eligible in Ohio 4 Currently Enrolled: 182,000 Ohioans 9% 91% 40% 60%

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Dual eligible beneficiaries are a diverse population 5

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – 6 Cognitively or Mentally Impaired 3+ Chronic Conditions In Fair or Poor Health Dual Eligible Consumers are sicker than other Medicare Consumers Functionally Impaired

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Answer 7 A coordinated, managed care system that brings together all consumer needs and services under one umbrella called MyCare Ohio Healthcare doctor & Hospital Long term Care (Passport, Assisted Living, nursing home care) Behavioral health/mental health

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – MyCare Ohio Demonstration to test integrated care and financing model for individuals with Medicare and Medicaid May 2014 to December 2017 Federal and State partnership How it will work: – Approved ICDS Plans will provide integrated benefits to Medicare and Medicaid enrollees in seven targeted geographic areas – Plans must provide all necessary Medicare and Medicaid- covered services, including Medicaid waiver services – Single identification card to access services 8

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – MyCare Ohio Three-way contract (Health plan, CMS, State) Rolling start in mid-2014; passive enrollment in Medicare delayed until January 1, 2015 Capitated rates adjusted for State and CMS upfront savings; also quality withhold Comprehensive care plans required incorporating client and family goals 9

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Medicare Passive Enrollment (I) – Beneficiaries must participate in MyCare Medicaid; but Medicare is optional – On , individuals who have not indicated a choice, was passively enrolled in MyCare Medicare with the same health plan as their MyCare Medicaid (integrated benefits and funding) 10

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Medicare Passive Enrollment (II) Individuals can choose to stay with traditional Medicare or another Medicare Advantage plan Beneficiaries can switch from MyCare Medicare to traditional Medicare, or vice versa at anytime This is all very confusing to consumers and public education has been poor 11

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – MyCare Ohio Demonstration 12

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Health Plans by Region 13 Northwest: Aetna and Buckeye Southwest: Aetna and Molina West Central: Molina and Buckeye Central: Aetna and Molina Northeast Central: CareSource and United East Central: CareSource and United Northeast: Buckeye, CareSource, United

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Who's Eligible? Age 18 and older at the time of enrollment Eligible for full Medicare Parts, A, B, and D and full Medicaid, and Reside in an ICDS Demonstration county Ohio Home Care or Transitions Carve-Out Waivers Receive AoD and/or Mental Health Services Passport or Choices Waiver Assisted Living Medicaid Waiver receiving Medicare and Medicaid 14

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – You're Not Eligible if You're: Under the age of 18 On a delayed Medicaid spend down – (Delayed) If other third party creditable health care coverage is available A person with Intellectual Disabilities (ID)or Developmental Disabilities (DD) served through an IDD 1915(c) HCBS waiver or an ICF-IDD Enrolled in PACE Participating in the CMS Independence at Home (IAH) demonstration 15

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – The Promise 16 Single Point of Contact Single ID Card for all Medicare and Medicaid Services Nurse Advice Live – 24 hours a day, 7 days a week Care Team – (Family, doctor(s), Care Coordinator, MyCare Ohio health plan, anyone else chosen) Better Care Coordination = Better Health outcomes Providers submit claims to 1 place Focus on Prevention and Wellness

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – The Promise (II) 17

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Benefits for Primary Care Providers – Identifiable care manager – phone and contact Access to all benefits and services Opportunity to enhance home and community-based services – WEB portal to access patient’s care plan – Assistance for your most complex patients – Opportunity to participate as part of Integrated Care Team – Potential to shift hospital dollars to community- based services 18

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Continuity of Care and Transition Requirements Health plans must ensure individuals have access to current providers and service levels at the time of enrollment. – Length of transition period differs by service. For prescription drugs, Medicare Part D transition requirements apply. – Health Plans must provide a one-time fill- 30 day supply - of an ongoing medication within the first 90 days of plan membership. – Residents in long term care facilities can receive multiple fills. 19

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Continuity of Care Requirements (Continued) During the transition, Health Plans will advise enrollees and providers that they have received care that would otherwise not have been covered. Ongoing basis, Health Plans must contact providers not part of their network with information on being credentialed as in-network providers. Health Plans must always reimburse an out-of- network provider of emergent or urgent care. Details: Plan Payment RequirementsPlan Payment Requirements 20

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Cost of Inaction 21

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Crisis in Quality 22 Absence of Patient- Centered Care Multiple Visits Multiple Docs Multiple Rx Fills Duplicate Tests & Procedures Too Frequently Hospitalized Too Frequently Readmitted to Hospital Little or No Info upon Discharge No One to Find & Arrange Non-Medical Services Inappropriat e Rx

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Implementation Issues Consumers losing Independent Providers (Homecare and Nurses) Non-medical Long-term Services and Support – under 60 Transportation issues Primary Care Providers – turning away patients Durable Medical Equipment –not authorized 23

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Ohio Consumer Voice for Integrated Care “What we do” 24 Consumer Advisory Council Regional Networks SWOC, NEOC Central State –ODM Federal - CMS Plans

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Critical Role of Provider and Consumer Engagement Dual eligible patients will benefit from your participation in planning and direct care provision in MyCare Ohio If MyCare Ohio is not successful, the alternatives may be less desirable for patients and providers Primary care and Geriatrics providers’ clinical leadership, when combined with consumer advocacy efforts, is more likely to have an impact 25

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – How can Providers Get Involved? Learn about MyCare Ohio Discuss good and bad observations with your health system, Area Agency on Aging, health plan medical directors, and State Medicaid office leadership Join advocacy organization list-serves Here’s the sign up link: roviders roviders 26

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – What You Can Do? “Vision” Be part of the solution Help recruit consumer spoke persons to share their story Identify and help recruit others to join Consumer Advocate Conference call – (last Friday of every month) The call in number (free call) and participant code is: (877) Participant code # Provide a feedback loop to the Plan, Regional and State Coalitions. 27

Working together, why your voice matter 3/14/2015 John Arnold – Project Director, OCVIC – Thank you John Arnold x UHCAN Ohio Ohio Consumers Visit /OCVIC