1. Early Indicators Project (EIP) Update One Care Implementation Council By: EIP Workgroup January 31, 2014 1

2. The Early Indicators Project (EIP)  Overall Goal  Assess early perceptions and experiences of MassHealth members eligible for One Care using multiple methods  Distinct from One Care programmatic evaluation or quality measures  Qualitative data sources  Five focus groups (two completed)  Two surveys (one completed)  Quantitative data sources  MassHealth enrollment data  MassHealth Customer Service  SHINE (Serving the Health Insurance Needs of Everyone)  One Care Ombudsman  One Care plans 2

3. EIP Workgroup  Workgroup is made up of 4 members of the IC, 3 MassHealth staff and 2 UMass Medical School staff; meets bi-weekly  IC representation  Olivia Richard  Ted Chelmow  Jeff Keilson  Dennis Heaphy  Workgroup members develop focus group and survey questions, determine methodologies, identify indicator elements, and develop reports 3

4. Today’s Update  Very Preliminary Findings  First two focus groups  One Care Survey #1  One Care Enrollment Indicators  Next Steps for EIP 4

5. One Care Focus Groups 1&2 5  Goal - understand perceptions and experiences of members enrolling in or opting out of One Care  Members invited by phone to participate  Selected from a randomly-generated list of members living in the target area  Confidentiality of information and voluntary nature of group emphasized  Focus group questions explored  Knowledge of One Care/Information about One Care  Making the Decision to Enroll in or opt out of One Care  Hopes for (Concerns about) One Care  Boston Focus Group – Chose to Enroll in One Care  December 16, 2013; 7 participants (13 registered)  Worcester Focus Group – Chose to Opt-out of One Care  December 19, 2013; 5 participants (9 registered)  Discussions audio-recorded; recordings are being transcribed

6. Preliminary Findings Self-selected members focus group (Boston)  Knowledge of and Information about One Care  All participants felt they understood One Care  All recalled receiving One Care Enrollment Packet  All found information clear and easy to understand  3 of the 7 participants had contacted MassHealth Customer Service and found CST to be helpful  None had contacted SHINE 6

7. Preliminary Findings Self-selected members focus group (Boston)  Making the Decision to Enroll in One Care  Most participants made efforts to confirm that providers, pharmacies and medications would be covered  Most discussed the decision with a primary care provider, family member or CST before deciding  Reasons for Enrolling  Less expensive co-payments for prescriptions  Having a care coordinator  Better dental coverage  One insurance/one insurance card 7

8. Preliminary Findings Self-selected members focus group (Boston)  Hopes for/Experiences with One Care  Care coordination – of the 7 participants:  3 participants had met with care coordinator  Positive interaction – “She’s very nice…she gave me her phone number and told me if I needed anything to just give her a call…”  2 participants had been contacted by care coordinator and were working to schedule initial meeting  2 participants had not yet heard from care coordinator  LTS Coordinator – of the 7 participants:  3 participants used LTSS; none had met with LTS coordinator  1 participant noted that the care coordinator said that LTS coordinators are “just starting up”  All seemed satisfied with One Care, but acknowledged that it is early – “I have yet to lean on them for major services” 8

9. Preliminary Findings Opted-out members focus group (Worcester)  Knowledge of and Information about One Care  All were familiar with One Care – of the 5 participants:  3 recall receiving Enrollment Packet; 2 only recall receiving a letter  All had a basic awareness of what One Care offers  Concerns about One Care information  Enrollment guide was “too generic…not specific enough”  “The letter just scared me…it basically said that One Care will replace your existing Medicare and MassHealth. I don’t want to replace it…if you want to add stuff to it, that’s fine…”  One Care website does not provide enough information. It needs:  List of providers that are part of One Care  List of medications covered under One Care  2 of the 5 participants had contacted CST; none had contacted SHINE 9

10. Preliminary Findings Opted-out members focus group (Worcester)  Deciding Not to Enroll in One Care  General consensus -- “If it’s not broke, don’t fix it”  Participants felt more secure having Medicare and Medicaid  Allows flexibility to explore treatments  Medicaid will back-up and pay for things Medicare will not  Some had providers that were not in One Care, or providers didn’t know if they were in One Care  Most participants had not attempted to confirm of medications were covered  2 of the 5 participants use LTSS (PCA services)  LTS Coordinator role is appealing, but not enough for them to enroll in One Care 10

11. Preliminary Findings Opted-out members focus group (Worcester)  Concerns about One Care: Participants thought they might…  Lose current doctors and medications  Not get care when needed for their complicated medical conditions  Have to wait for approvals for treatment  Have to wait to get appointments with One Care providers  Not be able to reach their Care Coordinator when needed  One Care is new and unknown  “…it doesn’t have any history behind it, so you really don’t know what is going to happen in a year or two.” 11

12. Focus Group Participants  Demographic information was collected from participants and will be provided in final report on One Care Focus Groups  Demographic and background information includes:  Age, gender, race, ethnicity, sexual orientation  Education and employment  Primary disability  Use of durable medical equipment  Use of/need for ADL assistance  Use of hospital, emergency room and LTSS in past year  Recent experience of homelessness 12

13. One Care Survey #1  Examined members’ perceptions and experiences of One Care during initial enrollment period  Covered 5 major areas:  MassHealth’s One Care Enrollment Information and the Enrollment Process  Members’ Decision-Making Regarding One Care  Reasons for enrolling  Reasons for opting-out  Reasons for waiting  Limited inquiry about early experiences in One Care (for those enrolled)  Getting Answers to Questions About One Care  Demographic, Background and Disability Information 13

14. One Care Survey #1  Administered as telephone interview to 3 groups of randomly selected members eligible for One Care (n=300)  Self-selected into One Care (Opt-in Group)  Opted-out of One Care (Opt-out Group)  Neither opted-in nor opted-out (Waiting Group)  300 interviews completed by UMMS Office of Survey Research from December 16 th to January 20 th  109 members who opted-in  125 members who opted-out  51 members who are “waiting”  15 members who were not sure which group they were in 14

15. 15 Note. All values are percentages; *Respondents could identify more than one source, so totals exceed 100%. Table 1. Respondents’ Perceptions of and Experiences with Information about One Care Group Opt-In (N=109) Opt-Out (N=125) Waiting (N=51) MassHealth Enrollment Information/Process%% MassHealth One Care Enrollment Packet Remember receiving packet90.886.472.6 Reviewed Information90.988.964.9 Ease of understanding OC enrollment guide Very easy/somewhat easy83.372.958.3 Somewhat difficult /very difficult12.221.937.5 Ease of understanding OC enrollment form Very/somewhat easy83.372.958.3 Somewhat /very difficult12.221.937.5 Importance of info in deciding about OC Very/somewhat important81.172.958.3 Not very/not at all important6.715.629.2 *Getting General Information About One Care Called MassHealth Customer Service33.934.47.8 Called or met with SHINE counselor19.36.40.0 Attended community info session/health fair6.47.23.9 Spoke to rep from One Care plan56.916.03.9 Spoke to doctor or other provider41.334.421.6 Got info from someone else12.814.45.9 None of the above12.836.862.8

16. 16 Note. All values are percentages; *Respondents could identify more than one reason, so totals exceed 100%. Table 2. Respondents’ Reasons for Decisions about One Care Group Opt-In (N=109) Opt-Out (N=125) Waiting (N=51) Reasons for Decision About One Care%% *Reasons for Enrolling (Opt –in) To get better services80.7-- To get additional services76.2-- To get less complicated health care71.6-- To lower my health care costs71.6-- To have a care coordinator52.3-- Someone recommended it41.3-- Other reasons31.2-- *Reasons for Not Enrolling (Opt-out) Happy with health care/One Care won’t be as good-76.0- Would lose an important provider-68.8- Would lose an important service-56.0- Care would be more complicated -51.2- Didn’t find answers to my questions about One Care-24.8- Would have to pay more for health care-23.2- Someone recommended it-24.8- Other reasons-33.6- *Reasons for Waiting to Decide (Waiting) Need more time to decide--84.3 Not sure what to do next--70.6 Want to discuss with someone first--68.6 Need more information--68.6 Other reasons--29.4

17. Survey #1 Respondents  Demographic information was collected from survey respondents and will be provided in final report on Survey #1  Demographic and background information includes:  Age, gender, race, ethnicity, sexual orientation  Education and employment  Primary disability  Use of durable medical equipment  Use of/need for ADL assistance  Recent experience of homelessness 17

18. One Care Indicators  Data will be collected from a variety of entities  MassHealth  One Care plans  Customer Service  SHINE  Ombudsman  Refined data elements based on ideas previously generated by the Implementation Council  Brief summary reports will be available starting in January  Dashboard will be developed 18

19. Total Enrollment 19  Effective January 1, total number of enrollees: 9,506  5,319 self-selection enrollments  4,187 round one auto-assignment enrollments (C1 only) Total Enrollment by Plan Commonwealth Care Alliance (CCA) 6,120 Fallon Total Care (FTC) 2,570 Network Health 816 Total9,506 19 total eligible members = approx. 82,000

20. *Auto-assignment round one effective date, January 1, 2014 * * Enrollment Over Time 20

21. Total Enrollment by County County New enrollments for Jan. 1, 2014 Total Enrollment Essex † 57*571 Franklin † 759 Hampden 1,5612,326 CCA 711 (46%)1,319 (57%) FTC 850 (54%)1,007 (43%) Hampshire 249347 CCA 73 (29%)138 (40%) FTC 176 (71%)209 (60%) Middlesex † 120810 Norfolk † 60366 Plymouth † 34250 Suffolk 1,2642,087 CCA 1,070 (85%)1,734 (83%) NH 194 (15%)353 (17%) Worcester 1,6732,689 CCA 393 (23%)874 (33%) FTC 1,073 (64%)1,354 (50%) NH 207 (12%)461 (17%) All Counties 5,0269,506 † CCA onlytotal eligible members = approx. 82,000 21

22.  F1 – Facility-based Care. Individuals identified as having a long-term facility stay of more than 90 days  C3 – Community Tier 3 – High Community Need. Individuals who have a daily skilled need; two or more Activities of Daily Living (ADL) limitations AND three days of skilled nursing need; and individuals with 4 or more ADL limitations  In CY2014, C3 split into two subsets:  C3B: for C3 individuals with certain diagnoses (e.g., quadriplegia, ALS, Muscular Dystrophy and Respirator dependence) leading to costs considerably above the average for current C3  C3A: for remaining C3 individuals  C2 – Community Tier 2 – Community High Behavioral Health. Individuals who have a chronic and ongoing Behavioral Health diagnosis that indicates a high level of service need  In CY2014, C2 split into two subsets  C2B: for C2 individuals with co-occurring diagnoses of substance abuse and serious mental illness  C2A: for remaining C2 individuals  C1 – Community Tier 1 Community Other. Individuals in the community who do not meet F1, C2 or C3 criteria One Care Rating Category Definitions 22

23. Total Enrollment F115 C3B95 C3A697 C2B190 C2A992 C17,515 Unavailable*2 Total9,506 Total Enrollment by Rating Category *Rating categories for two enrollments were unavailable at the time of this report. 23

24. Rating Category Enrollment by Plan F1 represents <1% of enrollments in each plan  This chart includes the first wave of passive enrollments, effective Jan. 1st  MassHealth only passively enrolled individuals in the C1 rating category in the first wave  As a result, the One Care plans’ percentage of C1 enrollments is inflated (for example, FTC’s C1 enrollment is very high because passive enrollments represent over three-quarters of its total enrollment)  The distribution of rating categories across plans will likely shift as assessments and future passive enrollment waves are completed 24

25. Opt-Outs  Total number of opt-outs as of January 1 st -- 15,567  Will be excluded from any future auto-enrollment  If eligible, can choose to enroll by self-selection at any time  Total opt-out number includes individuals who may be ineligible  Of the individuals who received a One Care enrollment package, ~19% have chosen to opt out  Of individuals who previously opted-out, 257 subsequently have chosen to enroll in One Care 25 Total Opt-Outs by County Essex1,950 Franklin316 Hampden2,484 Hampshire597 Middlesex2,856 Norfolk1,205 Plymouth903 Suffolk2,057 Worcester3,127 Non-Demo Counties72 Total15,567

26. Next Steps in EIP  3 additional focus groups will be conducted March-May 2014  Auto-enrollees; Spanish speaking enrollees; enrollees with intellectual disabilities and their caregivers  Final report in July 2014  Finalization of Survey #1 Report – February 2014  Fielding of Survey #2 – May 2014-December 2015  3,000 self-selected and auto-assigned enrollees  More comprehensive survey on continuity of care; assessments and care plans; Care Coordinator/LTS Coordinator experience; successes/problems  Telephone and mail, English and Spanish  Fielded in waves, approx. 120 days after each auto-assignment wave  Final report in March 2015  Ongoing indicator reports; eventual quarterly “dashboard”  Findings will be published on One Care website as available 26

27. Next Steps in EIP Early Indicators Public Information  Information presented today will be posted on the One Care website; click on News and Community section  www.mass.gov/masshealth/onecare www.mass.gov/masshealth/onecare  Indicator Reports posted by next week  Focus Group results will be posted within next 2 weeks  Survey #1will be posted once finalized in February 27