[NYAPRS Enews] Politico: State Medicaid Care (FIIDA) Initiative Failing To Launch

[Harvey Rosenthal]

State Medicaid Care Initiative Failing To Launch
By Dan Goldberg August 27, 2015

An ambitious state plan to improve the care for some of Medicaid's costliest patients isn't too popular with New Yorkers.

Seven months into the initiative, the Fully Integrated Duals Advantage (FIDA) program has enrolled about 7,700 people, while 54,287 others have opted out.

FIDA, approved by the federal Centers for Medicare and Medicaid Services in 2013, is a demonstration project that is enrolling New Yorkers who receive both Medicaid and Medicare into a single managed long-term care plan. State officials believe enrolling people in one plan, and providing them with one benefit card, will lead to better, more cost-efficient care.

These so-called "dual eligible" patients would have a single insurance plan for all their medical care instead of using both managed long-term care plans for some services and Medicare for primary care visits and acute episodes. The bifurcation of care can lead to an overlap in services, and is one reason why this population is so expensive.

In New York, the dual eligible population makes up about 15 percent of enrollees but accounts for approximately 45 percent of expenses.

Part of the FIDA plan requires participating physicians to partake in interdisciplinary meetings that help coordinate care for patients on the theory these meetings will help avoid unnecessary and expensive treatments. It also moves recipients away from a fee-for-service model and toward a capitated model, which pays providers a set amount for each patient.

The state is automatically enrolling the 700,000 "dual eligibles" but recipients may opt-out.

The state's health department did not respond to a request for comment on the numbers or its view of the program.

It's still early, and there is plenty of time for the numbers to improve. But there are reasons for concern.

Insurance companies, which have created these new networks, did so on the assumption they'd have enough customers to justify their costs. That hasn't happened, though insurance executives believe these are just the labor pains of a new program.

The low enrollment numbers are only part of the story, said Hany Abdelaal, president of VNSNY Choice, which has enrolled more than 2,000 members into its FIDA plan, more than any other insurer in New York.

"We're seeing a steady improvement in our numbers, and we're also working actively with providers to help educate them about the program's benefits," Abdelaal wrote in an internal newsletter that was shared with POLITICO New York. "FIDA is certainly experiencing some struggles right now-but that's to be expected when you roll out a new initiative of this magnitude."

Krystal Scott, New York State policy director at the Medicare Rights Center, said the numbers will improve over time as the program becomes betters known.

"What will change is we will have more experience from providers who will see positive experiences [for their patients]," she said. "People enrolled will share it with friends and neighbors. I think a year from now, more people will be actively enrolling."

The trouble, right now however, is there isn't a compelling reason for the numbers to change.

People are opting out because they don't see a benefit in being enrolled. The state's premise is that individuals will receive better care, but if a patient is satisfied with the care they receive, with the doctors they see, then there is very little incentive to jump through a new set of hoops.

"For beneficiaries, even if the system is inefficient, if you've got a workaround you don't necessarily want to jump to a new program," said Doug Goggin-Callahan, a vice president at Independence Care System, an insurer.

Physicians, wary of additional administrative burdens, new requirements and new networks have also encouraged patients to opt out, a trend that must cease before FIDA can turn around.

The other issue is that FIDA is one of several dozen programs the state is launching to improve the Medicaid program, and each has its own acronym. There's HARP, SHIP, DSRIP, FIDA among others.

"That creates its own kind of confusion," Goggin-Callahan said.

Other states have struggled with their rollouts as well, but their enrollment numbers dwarf New York's.

New York's 7,676 enrollees compares to nearly 153,000 in New Jersey, 122,000 in California, almost 62,000 in Ohio and 17,500 in Massachusetts. Those programs may be further along than New York's and no two states are alike but the numbers do demonstrate why insurers in New York are concerned.

"HPA is working with plans and has created a workgroup that will look to develop some solutions to address the concerns," said Leslie Moran, spokeswoman for the Health Plan Association, which represents insurers. "As part of this effort, HPA is looking to tap into the expertise from some of our national plans - United, Aetna - to examine the experience in other states, hoping to learn what worked in those states and what strategies New York might look to use."

http://www.capitalnewyork.com/article/albany/2015/08/8574872/state-medicaid-care-initiative-failing-launch
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