The Future of Integrated Care In New York State

  • Session 1 is also available in Portable Document Format (PDF)

Agenda:

  • The Future of Integrated Care In New York State
    • Andrew Segal, Division of Long Term Care, Department of Health
  • The Medicare–Medicaid Financial Alignment Initiative: Overview and Status Update
    • Lindsay Barnette, Medicare–Medicaid Coordination Office, Centers for Medicare & Medicaid Services
  • Other State Approaches to Integrating Medicare and Medicaid for Dually Eligible Beneficiaries: Implications for the New York State FIDA Demonstration
    • James Verdier, Mathematica Policy Research
    • Ann Mary Philip, Center for Health Care Strategies
  • Questions and Discussion
    • Erin Kate Calicchia, Division of Long Term Care, Department of Health

The Future of Integrated Care In New York State

The Future of Integrated Care In New York State

  • The Department´s goal is to increase integration of services, providers, payments, and delivery systems
  • Integration:
    • Advances quality, access, and value
    • Promotes a Total Cost of Care approach
    • Aligns with goals of VBP

Current Landscape of Integrated Care

  • Medicaid Redesign Team
    • Priority placed on Medicaid and Medicare alignment prompted FIDA Demonstration and PACE/MAP expansion
    • FIDA/PACE/MAP boast success in the following areas:
      • Coordination of care
      • Financial alignment
      • Elimination of service duplication
      • Enhancement of community–based care o Minimized reliance on institutional care o Increased health value and quality of life
  • FIDA:
    • Offers the most robust managed care service package available in NYS
    • Delivers a streamlined experience for participants and providers
    • Provides a person–centered care planning process and interdisciplinary team (IDT) approach
    • Includes flexibilities unavailable in other programs
      • Fully integrated appeals and grievances processes
  • MAP:
    • Combines the State´s standalone MLTC Partial Plan with a Medicare Advantage Plan
    • Manages and coordinates care through a care manager
      • Includes MLTC benefit package plus Medicare services
      • Does not include all Medicaid physical health services, Medicaid behavioral health, Medicaid HCBS Waiver services
  • PACE:
    • Person–centered care planning process
    • Interdisciplinary Team (IDT) approach
    • Services provided in an adult day health center
      • The adult day health center is supplemented by in–home and referral services
      • Health services are provided by a health care team of providers
    • New York is set to lead the nation in PACE advancement and growth

Value of Integrated Care

  • Experience of Care
    • Person–Centered Service Plan (PCSP)
    • Interdisciplinary Care Team (IDT) model
    • Tailored care management
    • Comprehensive provider networks
  • Experience of Providers
    • Increased participation in care coordination and planning
  • Alignment of Incentives
    • Enhancing the value proposition
    • Plan incentives
  • The Total Cost of Care
    • Individuals live safely in their homes and communities
    • Financial alignment
    • Value–Based Payment (VBP) could apply to integrated Plans

Challenges of Multiple Managed Care Products

  • Confusion amongst stakeholders and participants
  • Inefficiencies and duplication of efforts
  • Potential for cost shifting across payors for products that are not fully integrated

Objectives for Future Integration Planning Process

  • Achieve the greatest level of Medicare and Medicaid physical, behavioral, and LTSS integration possible
    • Identify platforms and incorporate best elements for integration
    • Offer stakeholders opportunities to help shape the future of integrated care
    • Allow sufficient lead time to ensure a smooth transition

Next Steps: Mapping a Strategy to Reach Integration Objectives

  • Learn about available platforms for integrated care
  • Review lessons learned from FIDA
  • Obtain input into future stakeholder process to collaborate on:
    • Finding the best vehicle to drive one integrated care product
    • Incorporating the best features of existing programs
    • Envisioning the transition process
    • Continue to work collaboratively with CMS

For More Information

FIDA BML: fida@health.ny.gov

MRT 101:
https://www.health.ny.gov/health_care/medicaid/redesign/mrt_101.htm

FIDA consumer website:
https://www.health.ny.gov/health_care/medicaid/redesign/fida/

MRT 90:
https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/index.htm

MLTC VBP Quality Measures:
https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/2017/docs/2017–06–02_mltc.pdf