Presentation on theme: "Michigan’s Journey to Integrated Care for Dual Eligibles Alison Hirschel Michigan Poverty Law Program & Michigan Voices for Better Health."— Presentation transcript:
Michigan’s Journey to Integrated Care for Dual Eligibles Alison Hirschel Michigan Poverty Law Program & Michigan Voices for Better Health
The Basics…Michigan’s demonstration project Implementation in four regions of the state beginning July 1, 2014 Will affect 104,000 individuals Most dually eligible individuals will be passively enrolled; all beneficiaries can opt out or change plans on a monthly basis.
A unique twist… Primary care, acute care, and long term services and supports will be provided by managed care organizations (“ICOs”) Mental/behavioral health services will be provided by existing managed mental health care system. (“PIHPs”) Care between the ICOs and the PIHPs will be coordinated across a “Care Bridge”
State’s goals for ICDE: Improved quality and enrollee satisfaction “Choice and voice” for consumers Seamless access to services
More goals for ICDE Increased access to home and community based care Effective, person-centered care coordination across acute, primary, mental health, and long term care Streamlined bureaucracy
Advocates’ Approach to ICDE State courted advocacy community for years seeking support first for concept of managed long term supports & services and, later, for ICDE. Advocates cautious but supportive Seeking new ways to solve intractable problems Significant, long-standing trust between state and advocacy community
Advocates’ Toolkit Rely on existing broad coalitions of aging and disability advocates With support of Community Catalyst, Atlantic Philanthropies, and Michigan Consumers for Healthcare, expand outreach efforts, utilize more sophisticated communications, learn from advocates in other states, and advocate with health plans & providers.
Advocacy Strategies Aging and disability communities present a united front, consistent message Maintain relationships Medicaid staff Offer help, be credible, show up in force Demand consumer involvement Provide real life stories/challenges to shape demonstration Say thank you when appropriate
Advocacy Successes Proposal, RFP, and MOU reflected shared vision, vocabulary, goals Person-centered, permits self-direction Promotion of home & comm’y based care Strong consumer role in governance of managed care organizations Shared vision of strong ombudsman program w/ legal support Many specific quality measures
More advocacy successes Consumer/advocacy involvement on all workgroups, funding and support to promote consumer engagement Unprecedented access to state officials; opportunities to review, edit or draft part/all of key documents Bifurcated delivery system to preserve perceived gains by mental health community (crucial to MH/ID community)
Limitations, challenges of “Michigan nice” Must balance value of access, trust, relationships with state officials and need to be uncompromising advocates Often reached agreement with state officials only to learn that CMS or Department’s legal counsel nixed plans Supported ICDE from start but saw advantages shrink due to unanticipated barriers and time/staff constraints.
Next steps Expand advocacy to health plans and provider networks Develop regional Advisory Councils Support consumers on managed care boards, state Stakeholder group Review, draft all consumer notices, info. Develop ombudsman program with both individual and systemic advocacy role
Thanks and Questions? Alison Hirschel Michigan Voices for Better Health Michigan Poverty Law Program firstname.lastname@example.org (517) 394-2985, x 231