Early Indicators Project (EIP) Update One Care Implementation Council

1. Early Indicators Project (EIP) UpdateOne Care Implementation Council By: EIP Workgroup January 31, 2014

2. The Early Indicators Project (EIP) • Overall Goal • Assess early perceptions and experiences of MassHealth members eligible for One Care using multiple methods • Distinct from One Care programmatic evaluation or quality measures • Qualitative data sources • Five focus groups (two completed) • Two surveys (one completed) • Quantitative data sources • MassHealth enrollment data • MassHealth Customer Service • SHINE (Serving the Health Insurance Needs of Everyone) • One Care Ombudsman • One Care plans

3. EIP Workgroup • Workgroup is made up of 4 members of the IC, 3 MassHealth staff and 2 UMass Medical School staff; meets bi-weekly • IC representation • Olivia Richard • Ted Chelmow • Jeff Keilson • Dennis Heaphy • Workgroup members develop focus group and survey questions, determine methodologies, identify indicator elements, and develop reports

4. Today’s Update • Very Preliminary Findings • First two focus groups • One Care Survey #1 • One Care Enrollment Indicators • Next Steps for EIP

5. One Care Focus Groups 1&2 • Goal - understand perceptions and experiences of members enrolling in or opting out of One Care • Members invited by phone to participate • Selected from a randomly-generated list of members living in the target area • Confidentiality of information and voluntary nature of group emphasized • Focus group questions explored • Knowledge of One Care/Information about One Care • Making the Decision to Enroll in or opt out of One Care • Hopes for (Concerns about) One Care • Boston Focus Group – Chose to Enroll in One Care • December 16, 2013; 7 participants (13 registered) • Worcester Focus Group – Chose to Opt-out of One Care • December 19, 2013; 5 participants (9 registered) • Discussions audio-recorded; recordings are being transcribed

6. Preliminary Findings Self-selected members focus group (Boston) • Knowledge of and Information about One Care • All participants felt they understood One Care • All recalled receiving One Care Enrollment Packet • All found information clear and easy to understand • 3 of the 7 participants had contacted MassHealth Customer Service and found CST to be helpful • None had contacted SHINE

7. Preliminary Findings Self-selected members focus group (Boston) • Making the Decision to Enroll in One Care • Most participants made efforts to confirm that providers, pharmacies and medications would be covered • Most discussed the decision with a primary care provider, family member or CST before deciding • Reasons for Enrolling • Less expensive co-payments for prescriptions • Having a care coordinator • Better dental coverage • One insurance/one insurance card

8. Preliminary Findings Self-selected members focus group (Boston) • Hopes for/Experiences with One Care • Care coordination – of the 7 participants: • 3 participants had met with care coordinator • Positive interaction – “She’s very nice…she gave me her phone number and told me if I needed anything to just give her a call…” • 2 participants had been contacted by care coordinator and were working to schedule initial meeting • 2 participants had not yet heard from care coordinator • LTS Coordinator – of the 7 participants: • 3 participants used LTSS; none had met with LTS coordinator • 1 participant noted that the care coordinator said that LTS coordinators are “just starting up” • All seemed satisfied with One Care, but acknowledged that it is early – “I have yet to lean on them for major services”

9. Preliminary Findings Opted-out members focus group (Worcester) • Knowledge of and Information about One Care • All were familiar with One Care – of the 5 participants: • 3 recall receiving Enrollment Packet; 2 only recall receiving a letter • All had a basic awareness of what One Care offers • Concerns about One Care information • Enrollment guide was “too generic…not specific enough” • “The letter just scared me…it basically said that One Care will replace your existing Medicare and MassHealth. I don’t want to replace it…if you want to add stuff to it, that’s fine…” • One Care website does not provide enough information. It needs: • List of providers that are part of One Care • List of medications covered under One Care • 2 of the 5 participants had contacted CST; none had contacted SHINE

10. Preliminary Findings Opted-out members focus group (Worcester) • Deciding Not to Enroll in One Care • General consensus -- “If it’s not broke, don’t fix it” • Participants felt more secure having Medicare and Medicaid • Allows flexibility to explore treatments • Medicaid will back-up and pay for things Medicare will not • Some had providers that were not in One Care, or providers didn’t know if they were in One Care • Most participants had not attempted to confirm of medications were covered • 2 of the 5 participants use LTSS (PCA services) • LTS Coordinator role is appealing, but not enough for them to enroll in One Care

11. Preliminary Findings Opted-out members focus group (Worcester) • Concerns about One Care: Participants thought they might… • Lose current doctors and medications • Not get care when needed for their complicated medical conditions • Have to wait for approvals for treatment • Have to wait to get appointments with One Care providers • Not be able to reach their Care Coordinator when needed • One Care is new and unknown • “…it doesn’t have any history behind it, so you really don’t know what is going to happen in a year or two.”

12. Focus Group Participants • Demographic information was collected from participants and will be provided in final report on One Care Focus Groups • Demographic and background informationincludes: • Age, gender, race, ethnicity, sexual orientation • Education and employment • Primary disability • Use of durable medical equipment • Use of/need for ADL assistance • Use of hospital, emergency room and LTSS in past year • Recent experience of homelessness

13. One Care Survey #1 • Examined members’ perceptions and experiences of One Care during initial enrollment period • Covered 5 major areas: • MassHealth’s One Care Enrollment Information and the Enrollment Process • Members’ Decision-Making Regarding One Care • Reasons for enrolling • Reasons for opting-out • Reasons for waiting • Limited inquiry about early experiences in One Care (for those enrolled) • Getting Answers to Questions About One Care • Demographic, Background and Disability Information

14. One Care Survey #1 • Administered as telephone interview to 3 groups of randomly selected members eligible for One Care (n=300) • Self-selected into One Care (Opt-in Group) • Opted-out of One Care (Opt-out Group) • Neither opted-in nor opted-out (Waiting Group) • 300 interviews completed by UMMS Office of Survey Research from December 16th to January 20th • 109 members who opted-in • 125 members who opted-out • 51 members who are “waiting” • 15 members who were not sure which group they were in

17. Survey #1 Respondents • Demographic information was collected from survey respondents and will be provided in final report on Survey #1 • Demographic and background information includes: • Age, gender, race, ethnicity, sexual orientation • Education and employment • Primary disability • Use of durable medical equipment • Use of/need for ADL assistance • Recent experience of homelessness

18. One Care Indicators • Data will be collected from a variety of entities • MassHealth • One Care plans • Customer Service • SHINE • Ombudsman • Refined data elements based on ideas previously generated by the Implementation Council • Brief summary reports will be available starting in January • Dashboard will be developed

19. Total Enrollment • Effective January 1, total number of enrollees: 9,506 • 5,319 self-selection enrollments • 4,187 round one auto-assignment enrollments (C1 only) total eligible members = approx. 82,000 19

20. Enrollment Over Time * * *Auto-assignment round one effective date, January 1, 2014

21. Total Enrollment by County †CCA only total eligible members = approx. 82,000

22. One Care Rating Category Definitions • F1 – Facility-based Care. Individuals identified as having a long-term facility stay of more than 90 days • C3 – Community Tier 3 – High Community Need. Individuals who have a daily skilled need; two or more Activities of Daily Living (ADL) limitations AND three days of skilled nursing need; and individuals with 4 or more ADL limitations • In CY2014, C3 split into two subsets: • C3B: for C3 individuals with certain diagnoses (e.g., quadriplegia, ALS, Muscular Dystrophy and Respirator dependence) leading to costs considerably above the average for current C3 • C3A: for remaining C3 individuals • C2 – Community Tier 2 – Community High Behavioral Health. Individuals who have a chronic and ongoing Behavioral Health diagnosis that indicates a high level of service need • In CY2014, C2 split into two subsets • C2B: for C2 individuals with co-occurring diagnoses of substance abuse and serious mental illness • C2A: for remaining C2 individuals • C1 – Community Tier 1 Community Other. Individuals in the community who do not meet F1, C2 or C3 criteria

23. Total Enrollment by Rating Category *Rating categories for two enrollments were unavailable at the time of this report.

24. Rating Category Enrollment by Plan • This chart includes the first wave of passive enrollments, effective Jan. 1st • MassHealth only passively enrolled individuals in the C1 rating category in the first wave • As a result, the One Care plans’ percentage of C1 enrollments is inflated (for example, FTC’s C1 enrollment is very high because passive enrollments represent over three-quarters of its total enrollment) • The distribution of rating categories across plans will likely shift as assessments and future passive enrollment waves are completed F1 represents <1% of enrollments in each plan

25. Opt-Outs • Total number of opt-outs as of January 1st -- 15,567 • Will be excluded from any future auto-enrollment • If eligible, can choose to enroll by self-selection at any time • Total opt-out number includes individuals who may be ineligible • Of the individuals who received a One Care enrollment package, ~19% have chosen to opt out • Of individuals who previously opted-out, 257 subsequently have chosen to enroll in One Care

26. Next Steps in EIP • 3 additional focus groups will be conducted March-May 2014 • Auto-enrollees; Spanish speaking enrollees; enrollees with intellectual disabilities and their caregivers • Final report in July 2014 • Finalization of Survey #1 Report – February 2014 • Fielding of Survey #2 – May 2014-December 2015 • 3,000 self-selected and auto-assigned enrollees • More comprehensive survey on continuity of care; assessments and care plans; Care Coordinator/LTS Coordinator experience; successes/problems • Telephone and mail, English and Spanish • Fielded in waves, approx. 120 days after each auto-assignment wave • Final report in March 2015 • Ongoing indicator reports; eventual quarterly “dashboard” • Findings will be published on One Care website as available

27. Next Steps in EIP Early Indicators Public Information • Information presented today will be posted on the One Care website; click on News and Community section • www.mass.gov/masshealth/onecare • Indicator Reports posted by next week • Focus Group results will be posted within next 2 weeks • Survey #1will be posted once finalized in February