scholarly journals Ohio’s Dual Eligible Population: Effects of Program Design and Implementation on Care Management

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 453-454
Author(s):  
Katherine Abbott ◽  
Athena Koumoutzis ◽  
Jennifer Heston-Mullins
Keyword(s):  
Managed Care ◽  
Care Management ◽  
Program Design ◽  
Service Providers ◽  
Coordinated Care ◽  
Term Care ◽  
Care Plans ◽  
Opt Out ◽  
Dual Eligible ◽  
Documentation Systems

Abstract MyCare Ohio is a prospective blended managed care payment model program tasked to provide comprehensive and coordinated care to Ohio residents who are dully eligible for Medicare and Medicaid. To understand the administration and day-to-day implementation of care management within MyCare Ohio, n=75 interviews with a total of n=331 personnel from Area Agencies on Aging, Managed Care Plans, and service providers were conducted. Interviews were audio recorded, transcribed, and checked for accuracy. Data were analyzed by iterative reviews and deductive coding in Dedoose. Respondents provided insights on how care management activities are affected by program design features (e.g., ability to opt-out of the Medicare component), transitions between acute and long-term care settings, documentation systems and data-sharing, and high numbers of beneficiaries with behavioral health diagnoses. Implications for practice and policy will be discussed.

Aligning Medicaid and Medicare Advantage Managed Care Plans for Dual-Eligible Beneficiaries

2021 ◽  
pp. 107755872110189
Author(s):  
Laura M. Keohane ◽  
Zilu Zhou ◽  
David G. Stevenson
Keyword(s):  
Nursing Home ◽  
Managed Care ◽  
Prescription Drugs ◽  
Service Use ◽  
Medicare Advantage ◽  
Percentage Point Increase ◽  
Care Plans ◽  
Point Increase ◽  
Dual Eligible ◽  
Home Users

To coordinate Medicare and Medicaid benefits, multiple states are creating opportunities for dual-eligible beneficiaries to join Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) and Medicaid plans operated by the same insurer. Tennessee implemented this approach by requiring insurers who offered Medicaid plans to also offer a D-SNP by 2015. Tennessee’s aligned D-SNP participation increased from 7% to 24% of dual-eligible beneficiaries aged 65 years and above between 2011 and 2017. Within a county, a 10-percentage-point increase in aligned D-SNP participation was associated with 0.3 fewer inpatient admissions ( p = .048), 13.9 fewer prescription drugs per month ( p = .048), and 0.3 fewer nursing home users ( p = .06) per 100 dual-eligible beneficiaries aged 65 years and older. Increased aligned plan participation was associated with 0.2 more inpatient admissions ( p = .004) per 100 dual-eligible beneficiaries younger than 65 years. For some dual-eligible beneficiaries, increasing Medicare and Medicaid managed plan alignment has the potential to promote more efficient service use.

scholarly journals INTEGRATING ACUTE AND LONG-TERM SERVICES: DOES IT WORK, CAN IT WORK, WILL IT WORK?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S229-S230
Author(s):  
Robert A Applebaum ◽  
Jennifer Heston
Keyword(s):  
Managed Care ◽  
Integrated Care ◽  
Care Management ◽  
Service Providers ◽  
Care Staff ◽  
Care Plan ◽  
Management Model ◽  
Management Models ◽  
The Impact

Abstract The expansion of managed long-term services and supports has generated considerable interest over the last decade. However, studies on the impact of these efforts have produced mixed findings. Additionally, there is limited information about the care management models used in implementation. This lack of data makes it impossible to assess whether differences in managed care plan approaches have an impact on participants. Our study sought to gain better understanding of the integrated care management models being implemented in Ohio’s MyCare Demonstration. Through qualitative interviews with 50 respondents, including area agency care managers, managed care staff, and service providers, we documented strengths and weaknesses of one integrated care management model used in Ohio’s demonstration. Understanding what is inside the black box of managed care/care management model implementation is key to gaining insights into whether such an approach can ultimately improve the health and long-term service systems for older people with disability.

scholarly journals Managed Long-Term Care Services: A Playbook Innovation or a Hail Mary?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 453-453
Author(s):  
Larry Polivka ◽  
Robert Applebaum
Keyword(s):  
Managed Care ◽  
Preliminary Evaluation ◽  
Demonstration Program ◽  
Term Care ◽  
Administrative Practices ◽  
Care Plans ◽  
Care Services ◽  
Research Findings ◽  
Services And Supports

Abstract The approach to providing long-term services and supports (LTSS) has changed dramatically over the last three decades in both the financing and delivery arenas. In the U.S., long-term strategies have varied by state in organizational structure, scope of delivery and administrative practices. In the past two decades an additional change has emerged with over half the states adopting some form of managed LTSS. This shift has deepened the divide in state approaches to LTSS system design and delivery. The shift to managed LTSS has been largely fueled by ideological expectations and concerns about growing Medicaid costs: Empirical research findings have played a minimal role. For example, the large CMS evaluation conducted in this area did not include Medicaid data or encounter data from the managed care plans as part of the study efforts. However, the managed LTSS experiment does create an opportunity to compare costs and outcomes of these different models of financing and delivery. This symposium will present preliminary evaluation findings from two states, Ohio and Pennsylvania, which are generating data to assess both the implementation and outcomes of these alternative LTSS models. To set the context an initial paper will discuss the expansion of managed LTSS programs across the nation and examine how these efforts compare to the development occurring in the European LTSS systems. The third presentation will discuss the results of the Community Catalyst dual eligibles’ managed care demonstration program monitoring project.

scholarly journals ORGANIZATION OF WORK AND DECISION-MAKING OF PROFESSIONALS WORKING IN NURSING HOMES IN CATALONIA (SPAIN)

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S699-S699
Author(s):  
Montserrat Gea-Sánchez ◽  
Alvaro Alconada-Romero ◽  
Roland Pastells-Peiró ◽  
Filip Bellon ◽  
Lourdes Teres-Vidal ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Homes ◽  
Long Term Care ◽  
Holistic Approach ◽  
Positive Outcomes ◽  
Coordinated Care ◽  
Structured Interviews ◽  
Term Care ◽  
Care Plans

Abstract The long term care environment demands specific requirements of the staff, namely that they provide a holistic approach to care. Providing holistic care leads to complex decision-making processes which go beyond just finding a solution to a specific health problem. It requires that staff are able to respond to the diverse needs expressed by the residents and which, in many cases, are only identified through the relationship that professionals have with them. However, this relationship that staff establishes with the resident often leads to burden for these professionals. The researchers sought to identify characteristics of the nursing homes that lead to positive outcomes for staff. The study involves collecting questionnaires (n=132) and conducting semi structured interviews (n=35) in 9 Catalan nursing homes with number of staff, utilizing a quantitative questionnaire and semi-structured interviews. Practices in organisations that led to positive outcomes for staff included coordinated care that includes processes of support for staff, effective communication and decision making practices, clear responsibilities for staff, and utilization of care plans. Effective long term care practices can favour both patient care and professional practice in residences for elderly.

Comparing Care for Dual-Eligibles Across Coverage Models: Empirical Evidence From Oregon

2017 ◽  
Vol 76 (5) ◽  
pp. 661-677 ◽  
Author(s):  
Hyunjee Kim ◽  
Christina J. Charlesworth ◽  
K. John McConnell ◽  
Jennifer B. Valentine ◽  
David C. Grabowski
Keyword(s):  
Managed Care ◽  
Financial Incentives ◽  
Service Use ◽  
Fee For Service ◽  
Care Plans ◽  
Dual Eligibles ◽  
Dual Eligible ◽  
Coverage Models ◽  
Substantial Heterogeneity

Dual-eligible beneficiaries or “duals” are individuals enrolled in both the Medicare and Medicaid programs. For both Medicare and Medicaid, they may be enrolled in fee-for-service or managed care, creating a mix of possible coverage models. Understanding these different models is essential to improving care for duals. Using All-Payer All-Claims data, we empirically described health service use and quality of care for Oregon duals across five coverage models with different combinations of fee-for-service, managed care, and plan alignment status across Medicare and Medicaid. We found substantial heterogeneity in care across these five coverage models. We also found that duals in plans with aligned financial incentives for Medicare and Medicaid experienced more improvement in their care relative to those with nonaligned Medicare Advantage and Medicaid managed care plans. These results highlight the importance of developing policies that account for the heterogeneity of the dual population and their coverage options.

Dx For A Careful Approach To Moving Dual-Eligible Beneficiaries Into Managed Care Plans

2012 ◽  
Vol 31 (6) ◽  
pp. 1186-1194 ◽  
Author(s):  
Patricia Neuman ◽  
Barbara Lyons ◽  
Jennifer Rentas ◽  
Diane Rowland
Keyword(s):  
Managed Care ◽  
Care Plans ◽  
Dual Eligible

scholarly journals Empowering Caseworkers to Better Serve the Most Vulnerable with a Cloud-Based Care Management Solution

2020 ◽  
Vol 11 (04) ◽  
pp. 617-621 ◽  
Author(s):  
Jane L. Snowdon ◽  
Barbie Robinson ◽  
Carolyn Staats ◽  
Kenneth Wolsey ◽  
Megan Sands-Lincoln ◽  
...  
Keyword(s):  
Health Care ◽  
Care Management ◽  
Well Being ◽  
Determinants Of Health ◽  
Coordinated Care ◽  
Management Tools ◽  
Care Plans ◽  
Disadvantaged Groups ◽  
Socially Disadvantaged ◽  
Sonoma County

Abstract Background Care-management tools are typically utilized for chronic disease management. Sonoma County government agencies employed advanced health information technologies, artificial intelligence (AI), and interagency process improvements to help transform health and health care for socially disadvantaged groups and other displaced individuals. Objectives The objective of this case report is to describe how an integrated data hub and care-management solution streamlined care coordination of government services during a time of community-wide crisis. Methods This innovative application of care-management tools created a bridge between social and clinical determinants of health and used a three-step approach—access, collaboration, and innovation. The program Accessing Coordinated Care to Empower Self Sufficiency Sonoma was established to identify and match the most vulnerable residents with services to improve their well-being. Sonoma County created an Interdepartmental Multidisciplinary Team to deploy coordinated cross-departmental services (e.g., health and human services, housing services, probation) to support individuals experiencing housing insecurity. Implementation of a data integration hub (DIH) and care management and coordination system (CMCS) enabled integration of siloed data and services into a unified view of citizen status, identification of clinical and social determinants of health from structured and unstructured sources, and algorithms to match clients across systems. Results The integrated toolset helped 77 at-risk individuals in crisis through coordinated care plans and access to services in a time of need. Two case examples illustrate the specific care and services provided individuals with complex needs after the 2017 Sonoma County wildfires. Conclusion Unique application of a care-management solution transformed health and health care for individuals fleeing from their homes and socially disadvantaged groups displaced by the Sonoma County wildfires. Future directions include expanding the DIH and CMCS to neighboring counties to coordinate care regionally. Such solutions might enable innovative care-management solutions across a variety of public, private, and nonprofit services.

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