Transcript Hearing from Medicare-Medicaid Enrollees: Findings from 2011 Focus Groups Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services December 2011

Hearing from Medicare-Medicaid
Enrollees: Findings from 2011 Focus
Groups
Medicare-Medicaid Coordination Office
Centers for Medicare & Medicaid Services
December 2011
Medicare-Medicaid
Coordination Office
• Section 2602 of the Affordable Care Act (ACA)
• Purpose: Improve quality, reduce costs, and improve
the beneficiary experience.
– Ensure dually eligible individuals have full access to the
services to which they are entitled.
– Improve the coordination between the federal government and
states.
– Develop innovative care coordination and integration models.
– Eliminate financial misalignments that lead to poor quality and
cost shifting.
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Focus Group Objectives
• Gain insight as to how Medicare-Medicaid enrollees make
enrollment decisions, including, where available, the
decision to enroll in coordinated care.
• Learn more about how enrollees experience various types
of Medicare and Medicaid service delivery combinations.
• Identify language used by enrollees that could improve
communication efforts.
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Focus Group Sites
The Dalles
WA
Portland
Roseburg
Milwaukee
OR
OR
ME
MN
WI
WI
NY
MA
CT
MI
PA
PA
Oakland
Philadelphia
CO
CA
CA
Pittsburgh
KY
NC
TN
Riverside
OK
NM
NM
Gallup
Albuquerque
SC
TX
FL
Key Site Selection Factors
• Service delivery choices available (integrated and
separate Medicare-Medicaid combinations).
• Medicare-Medicaid enrollee sub-populations
reachable.
• Local partners willing to assist.
• Opportunity to contribute to demonstration planning.
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Participants
• 156 people in 21 groups.
• Mostly 18-64 years (3 groups were 65+).
• Persons with physical disability, serious mental illness,
developmental disability, multiple chronic illnesses, LTSS
need, and “no particular condition” were all represented.
• One Chinese speaking group.
• One group with Navajo majority.
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Knowledge of Medicare and Medicaid
• Wide variation in participants’ understanding of
Medicare and Medicaid differences.
– Some could detail the differences with great accuracy and
specificity including that Medicare is the primary payer.
– Many associated Medicare with hospital coverage and some
knew Medicaid covers long-term supports and services.
– Others only knew that they were separate programs.
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Enrollment Choices
• Most participants could not recall how they had come
to have their current Medicare and Medicaid service
delivery options.
• Several said it had “just happened automatically.”
• Some said they had been advised to join a particular
plan by a doctor, case worker, friend or family member.
“I’d like to be on [the combined plan], but my psychiatrist won’t take it,
so I have to stay on straight Medicare.”
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What do Medicare-Medicaid Enrollees look for?
• Physician and/or psychiatrist in network.
• Benefits:
–
–
–
–
Dental and eye care
Transportation
Prescription drugs
Persons with physical disabilities cited DME and personal care
• Cost (low/no premium and copays).
• Familiarity.
• Streamlined benefits administration.
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How would Medicare-Medicaid Enrollees like to
receive information?
• Written information that simply states what is covered,
what is not, and the cost.
• Up-to-date provider directories (including whether or not
taking new patients).
• Navajo participants asked for in-person meetings, in
their language, on the reservation.
• Most participants cited poor access to the Internet and
frustration with automated phone information.
“Well they can be quite overwhelming, you know. You don’t
understand what they’re offering.”
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What Medicare-Medicaid Enrollees Want in
Doctors
•
•
•
•
Taking the time needed at appointments.
Listening.
Explaining things in simple language.
Being able to get an appointment or to talk to the PCP
on the phone.
“[My doctor] listened to me. He made sure that whatever concerns I
had or whatever he thought it was that I needed to take care of,
he took care of.”
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Transitions
• Persons with serious mental illness experienced
particularly poor communication between hospitals
and their community teams.
• Participants reported being discharged with new
medication, and follow-up instructions that did not
reference their community teams.
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Coordination of Care vs. Coordination of
Benefits
•
•
Participants were much more focused on coordination of benefits than
coordination of care.
Coordination Of Benefits
– Coordination of benefits issues included balance billing, difficulty getting
authorization for service, and “getting the run-around” between Medicaid and
Medicare.
– Participants in integrated programs expressed much greater satisfaction with
coordination of benefits than those is separate programs.
•
Coordination of Care
– Participants who did not belong to combined plans more frequently reported
multiple people helped them with care coordination.
– Participants in combined plans more frequently reported single-points of contacts
that could help resolve problems/access care.
“In regards to having a problem…you have to call both numbers to get it resolved. And I
was thinking, it would be just so nice if I could call one number and have it resolved.”
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Medicare-Medicaid Enrollee Language
Medicare-Medicaid Enrollees Do Not Medicare-Medicaid Enrollees Do Say
Say
I am dually eligible.
I get both. I have Medicare and
Medicaid. I have two cards.
I have fee-for-service Medicare.
I have regular Medicare. I’m on
straight Medicare.
I receive long term services and
supports.
I get 60 hours of help a month.
I have integrated care.
I have comprehensive care. I have
everything in one.
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Policy Relevance
• Overall
– Need for greater person-centered care coordination that crosses all
aspects of care rather than in a compartmentalized way.
– Important not to forget to look at how Medicare-Medicaid enrollees
experience care at the front end (e.g., member materials, insurance
cards, point of contacts, etc.) and other administrative issues.
• CMS/MMCO
– Support/refine ongoing work to improve quality and experience of
care for Medicare-Medicaid enrollees
• Alignment Initiative
• State demonstration design
– Improve how CMS directly communicates with enrollees (e.g., use
language that will better resonate, simplify materials, etc.)
Questions & Suggestions:
[email protected]
For more information, visit:
http://www.cms.gov/medicare-medicaid-coordination/