Health Innovation Highlights: January 9, 2019

Full Edition

Health Innovation Highlights Going Monthly in 2019

To our Readers: After publishing Health Innovation Highlights on a biweekly basis the past three years, the Center is changing it to a monthly publication, emailed on the second Wednesday of each month, beginning with this issue. We will continue to bring you the same quality of news and resources you have come to expect. As always, thank you for your continued readership and support!


End of 2018 Center Resource Roundup

Happy New Year! Welcome back! In case you missed these resources before you headed out for some well-deserved R&R, check out a few recent publications from the Center:

  • New Guide to Screening for Social Needs: Recognizing the growing consensus that addressing the social determinants of health is key to improving health outcomes, the Center has released a new resource on incorporating screening for social needs into the fabric of the health system.
  • Quick Take on Latest Duals Demonstration Evaluations: The Center’s Senior Policy Analyst Leena Sharma offers an initial analysis of the recently-released evaluations by the Medicare-Medicaid Coordination Office on the dual eligible demonstration projects. 
  • Care That Works: Elder Partnership for All-Inclusive Care (ElderPAC): The fourth brief in our “Care That Works” series reports on ElderPAC, a home-based primary care program that delivers a comprehensive blend of medical care and home and community-based services to frail older adults with multiple complex chronic conditions and functional impairments in their homes.

CMS-Sponsored Webinar to Feature Center Staff

Center Senior Policy Analyst Leena Sharma and Research Director Marc Cohen will be featured speakers on the Jan. 30 webinar, Successfully Engaging Members in Plan Governance, presenting new research on member advisory bodies operating within Medicare-Medicaid Plans (MMPs). Plan representatives will also share information about the composition, function, and impact of member engagement in their plans’ governance as well as lessons for building a culture of engagement within plans or other systems serving people with complex health and social needs. This webinar is the first in a three-part series on how health plans engage members in defining, designing, participating in, and assessing their care systems. See Key Dates section below to register and join the webinar.

Center, Partner Receive Tufts Health Plan Foundation Grant

In December, the Center, in partnership with the Rhode Island Organizing Project (RIOP), was awarded a two-year grant for $125,000 from Tufts Health Plan Foundation to train Rhode Island older adults as effective advocates and educated health care consumers. This grant is one of 11 new community investments totaling more than $1.2 million that reflect the Foundation’s commitment to advancing policies and practices that support healthy aging, including addressing gaps in oral health, nutrition, housing, transportation and community safety.

The Center and RIOP will use the Lift Up Your Voice! curriculum, which will be offered in English and Spanish, to train English and Spanish-speaking older adults for health care advocacy and engagement. We’re thrilled to receive this award from Tufts Health Plan Foundation and look forward to continuing our work with RIOP to develop a sustained health care consumer base in Rhode Island.

Video of Center Webinar Now Available: Tips, Tricks and Trends for Building Effective Partnerships through Hospital Community Benefit   

Community Catalyst convened a panel of experts on Dec. 21, 2018 to tackle the most pressing questions from community partners and public health professionals about working with hospitals on federally-mandated community health needs assessments (CHNAs) and provide best practices for navigating the CHNA process. The full video of the webinar presentation is now available.


MMCO: Updated Enrollment Reports, 2006-2017

The Medicare-Medicaid Coordination Office released two updated data briefs about enrollment trends at the end of 2018. The first report summarizes enrollment trends among dually eligible individuals from 2006 through 2017. The second report examines monthly point-in-time Medicare managed care enrollment trends on a quarterly basis for the same period. This brief includes the Medicare-only population for comparison purposes, but CMS plans to eventually expand their comparative analysis to include Medicaid.

Disability Advocates Highlight the Importance of Inclusivity in Disaster Planning

A Huffington Post story discusses how a lack of inclusivity when conducting disaster planning can mean that individuals with disabilities are left without many options when disaster strikes. The recent Camp Fire in Butte County, CA tragically illustrated the shortcomings in disaster response for people with disabilities. First responders and volunteers may not be knowledgeable about the needs of individuals with disabilities, facilities may lack appropriate medical equipment and inaccessible community evacuation plans may mean that people are left behind. While some communities have begun bringing advocates to the table to help incorporate the needs of the disability community into disaster plans, more work is needed to ensure that disabled individuals continue to have access to the medical and social support they need during an emergency.

New Report Details How States are Using 1115 Demonstrations to Address Social Determinants of Health

A new report from the Association for Community Affiliated Plans and the Center for Health Care Strategies , evaluates Medicaid managed care contracts from 40 states to see how states are addressing the social determinants of health (SDOH) through requirements and incentives. Overall, the review found that there is a growing, but varied, focus on SDOH in managed care contracts and 1115 demonstrations. In addition to providing an in-depth look at what states are doing to address SDOH in managed care, the report also details five federal policy recommendations that would support additional creativity and innovation on SDOH at the state level.



There are three new updates for the California Coordinated Care Initiative:

1. Under California’s Coordinated Care Initiative, the Multipurpose Senior Services Programs (MSSP) will transition from a federal 1915(c) Home and Community-Based Services (HCBS) waiver to a fully integrated Medicaid managed care benefit January 1, 2020. The state’s Department of Health Care Services (DHCS) and the California Department of Aging (CDA) have organized a Model of Care Workgroup composed of MSSP sites and managed care plans.

This Workgroup is tasked with developing recommendations for a model of care for the new Home and Community-Based Services Care Planning and Management (HCBS CPM) benefit that will take the place of the MSSP program in CCI Counties. The first set of recommendations have been completed and the DHCS and CDA are seeking public comment on this second set of Model of Care recommendations, which are available here . The public comment period will be open from now until close of business on Friday, February 8. The second set of recommendations include:

  • Assessment and Development of the Care Plan: The Workgroup recommends that providers determine a service or item as necessary to prevent elevation to a higher level of care.
  • Emergency Care Plan: The Workgroup recommends that the provider create an Emergency Care Plan in the event that the specified services or items will be purchased.
  • Informal and Formal Resources: Before purchasing items or services, the provider should determine if the service can be provided by the beneficiary’s support network, Medi-Cal, and/or a local organization.

2. The Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) are seeking comments from stakeholders on ways to continue to strengthen and improve the demonstration program. They are looking for new ideas on how Cal MediConnect (duals demonstration) can provide a better member experience or otherwise improve care and care coordination. This comment opportunity comes at a time when the state and CMS are working towards approval of a three-year extension to Cal MediConnect.

3. Last month the state posted results from July’s targeted focus groups of Cal MediConnect (duals demonstration) enrollees. The purpose the focus groups was to better understand the beneficiary experience in Cal MediConnect related to:

  • Program satisfaction,
  • Service integration,
  • Care coordination, and
  • Overall well-being and quality of care

Ten focus were conducted from Los Angeles and San Mateo counties and interviewed 68 participants, including Spanish-language beneficiaries and consumers of Long-Term Services and Supports (LTSS).

The summary report of findings was published in August 2018. Some of the key findings are:

  • Participants were satisfied with their medical and prescription coverage, access to additional benefits (dental, vision, hearing aids, transportation, health clubs) and good quality providers in convenient locations.
  • Some beneficiaries also discussed dissatisfaction with being referred to providers who did not speak their native language and reported that it negatively impacted their experience and care.
  • Though many focus group participants could not identify their care coordinators, some reported that assistance from their care coordinators was extremely helpful when dealing with difficult insurance and medical system issues. For example, addressing inappropriate billing, long wait times for appointments, denial of drug coverage, and for identifying participating providers).
  • Most LTSS participants described positive experiences when they transitioned from hospital/nursing care to their home. They shared that this was due to combined efforts from their plan or plan care coordinators, doctors, and the hospital.

Based on findings, the report also contains conclusions and detailed recommendations for participating health plans to better coordinate care and improve services like transportation, network adequacy, and specialized outreach to Spanish-speaking members. Lastly, the report concludes that Spanish-speakers can especially benefit from care coordination including receiving assistance with accessing services and more generally navigating the insurance and health care systems.

New York

As reported by Health Management Associates, New York’s duals demonstration program, the Fully Integrated Duals Advantage (FIDA), will close enrollment in June with the entire program ending at close of the year. While FISA began in 2015 with 23 plans, there are only six plans which continue to participate serving only 4,700 enrollees. The state health department notes that the program required a lot of resources and staffing for a very small population. They also indicated that they are conducting a post mortem to better understand what plans did and did not like about the program.


Wednesday, Jan. 30 (12:30-2 p.m. Eastern) - Webinar: Successfully Engaging Members in Plan Governance, presented by The Centers for Medicare and Medicaid in collaboration with the Center for Consumer Engagement in Health Innovation. Please register for the webinar.

Wednesday, Jan. 30 (12-1 p.m. Eastern) - Webinar: Building Capacity to Include People Who Have Disabilities, presented by The Association of University Centers on Disabilities. Please register for the webinar.