July 2013 marked the implementation of the Duals Demonstration by the Centers for Medicaid and Medicare Services (CMS). The demonstration tests financial alignment models and the integration of administrative functions for beneficiaries eligible for both Medicare and Medicaid. In this session:

• Hear an update on the initial stages of the demonstration
• Review the expectations at the start of the program and discuss how the program differs from these initial expectations
• Discuss the future of the program after the three-year pilot is complete

CMS launched the Duals Demonstrations with the goal of improving care and controlling costs for dual eligibles. Even though states have similar goals to improve care for this population, they have mixed interest in the Duals Demonstration Program, with 12 states involved in some way, 8 states that withdrew proposals to join, and 24 states not participating.

• Uncover how various states came to different decisions about their participation in the CMS-launched program
• Understand how the management of the dual eligible population differs for those involved and not involved in the Duals Demonstration

Dual eligibles have the option to opt-out of the Duals Demonstration at the start of the program and then again at the start of each month thereafter. Initial findings show that an unexpectedly high amount of duals chose not to participate in the program or joined and later dropped out. It is unclear what this means for the future of the program.

• Learn the opt-out rates for the Massachusetts Duals Demonstration both at the start of the program and now
• Realize the significance of over 40% of duals opting out of the program and discover who is choosing not to participate
• Examine whether the opt-out rates will change and what this means for the future of the Duals Demonstration

Dual eligible beneficiaries generally have multiple chronic conditions and require very complex, expensive care. The opportunity exists to improve care in order to lower costs and better outcomes, but it is often unclear where to begin when adjusting strategies and care plans.

• Realize the ROI for accessing and analyzing data on this population
• Develop plans for creating systems, infrastructure, and data governance to efficiently incorporate and use this data
• Understand how to efficiently use data to determine where to dedicate resources

In 2006, non-urgent emergency department visits accounted for over 18 billion dollars nationally. Research indicates that high-utilizers of emergency departments have common characteristics, making it possible to identify unnecessary visits.

• Discuss tools for identifying high utilizers of the ER
• Discover strategies for reducing ER visits among the dual eligible population
• Uncover ways to engage providers to prevent members’ use of the ER for primary care
• Recognize different approaches for engaging members and care teams to decrease ER utilization

Dual eligibles generally qualify for benefits in addition to Medicare and Medicaid and often require care from numerous types of providers.

• Learn effective strategies for coordinating several benefit providers
• Discover ways to increase care coordination across specialties
• Discuss best practices for educating providers who care for this complex population

Star ratings are a major focus for health plans, as they impact member enrollment and bonus payments. Unfortunately, social determinants, not solely medical conditions, can play a major role in the measurements used to assign star ratings.

• Discover which social and medical determinants impact Star metrics
• Hear an update on the debate regarding whether star rating reviews will incorporate social determinants as a factor in evaluation
• Discuss ways to improve star ratings even while managing a vulnerable population within the current rules and standards of star ratings
• Uncover case studies to illustrate dual impact on HEDIS, CAHPS, HOS and PDE

Due to the mobile nature of the dual eligible population, it is very difficult to contact and keep in touch with this group. After effectively reaching this population, increasing engagement remains a struggle. With a high-risk, high-cost population, engagement is especially important to increase compliance, improve care, and retain these members.

• Overcome the hurdles to reaching and communicating to a population that is constantly mobile
• Explore strategies for encouraging members’ active involvement in their health care
• Discuss ways to sustain engagement over the long term in order to improve outcomes and retain members