“Currently, 15 states have been selected to receive funding, data and technical assistance from CMS to develop a more-coordinated model of care for dual eligibles,” Rep. Joe Pitts (R-Pa.), chairman of the House Energy and Commerce's Health Subcommittee, said at the start of the hearing. Melanie Bella, director of the CMS' Medicare-Medicaid Coordination Office established in the health reform law, testified that those 15 states have been awarded $1 million contracts to design integrated approaches to coordinate primary, acute, behavioral health and long-term care. The 12-month program began in April, she said.
According to Bella, her office is focusing on three broad areas to improve access and care coordination for dual-eligible enrollees: program alignment, data and analytics, and models and demonstrations. As part of that effort, the Medicare-Medicaid Coordination Office last month began a process for states to access Medicare data to help them advance coordinated-care models for enrollees.
“By giving states these data, we support their efforts to identify high-risk individuals, to provide the data to primary-care providers and care managers who are developing care plans to prevent hospitalizations, for example, or to reduce medication errors or medications that are going to have adverse effects with each other,” Bella said in answer to a question from Pitts on why the availability of this data is important.
A second panel of witnesses testified about integrated-care models already in place, such as Community Care of North Carolina, an organization of regional networks of healthcare providers, physicians, hospitals, health departments and social service agencies. CCNC serves as a central office to help coordinate the efforts of these networks statewide, according to the testimony of Denise Levis Hewson, CCNC's director of clinical programs and quality improvement. The group creates medical homes that match each patient with a primary-care provider who oversees a team.
Earlier in the hearing, Bella said her office is evaluating how the accountable care organization model could be applied to the dual-eligible population.
“We're thinking about how do you adapt more of a managed fee-for-service approach that has an accountability like an ACO that brings in the long-term-care side for this population,” she said.