Seniors with low incomes who received Medicare and Medicaid in four regions are benefiting from a managed care approach to their health care needs delivered members of the Michigan Association of Health Plans, according to a new report on a state pilot project prepared for Centers for Medicaid & Medicaid Services (CMS), the federal government agency that oversees the Medicare-Medicaid Financial Alignment Initiative (FAI).
The report on MI Health Link, Michigan’s Medicare-Medicaid integration model serving 40,000 “dual-eligible” individuals around the state, shows that smartly delivered health care managed through private health plans has led to a:
- 17.8 percent reduction in the probability in monthly preventable emergency room visits
- 13.9 percent reduction in probability of inpatient admission
- 13.8 percent reduction in the probability of chronic ambulatory care sensitive condition admission (those are conditions such as bacterial pneumonia, urinary tract infection and dehydration that can lead seniors to be checked into hospitals)
- 12.8 percent reduction in the probability of overall ambulatory care sensitive condition admission.
Surveys of beneficiaries “found that participants were generally pleased with their plans and access to providers. Participants were most pleased with the lack of co-payments for prescriptions. They generally have been satisfied with care coordination and most had been visited by their care coordinators…” the report says.
“Our members have worked hard to develop programs that ensure these dual-eligible individuals get the care they need when they need it, to avoid serious and expensive long-term health conditions,” said Dominick Pallone, executive director of MAHP. “And the surveys of those who are receiving benefits show they think the management of health care is being done well. That’s a win-win for individuals and Michigan.”
The report noted that the program is hitting goals even though it is missing a critical component – the ability of health plans to integrate behavioral health services into the overall care management of member health. Many individuals have mental health challenges that are created by physical health issues, and vice versa.
“We are confident that even better outcomes are possible, if our members are given the opportunity to fully integrate physical and mental health service delivery,” Pallone said. “The current system, which separates mental and physical health management, is wasteful and failing to meet the needs of patients.
“We hope that based on this success, the state will move ahead to integrate care for dual eligible individuals – and expand on that so that the state’s entire Medicaid population will be able to benefit from integrated care delivered by health plans that take on financial responsibility for the care of their beneficiaries,” Pallone said.
Language in the current state Department of Health and Human Services budget before Gov. Gretchen Whitmer, known as Section 298, paves the way for pilot programs to allow health plans to provide integrated care.