New managed care system to coordinate medical and long-term care for SW Ohio adults

Tuesday, January 29, 2013

Council on Aging is helping to implement a new joint federal state project designed to improve care and reduce costs for people who are eligible for both Medicare and Medicaid. Called the Integrated Care Delivery System (ICDS), the three year pilot project aims to improve health outcomes while saving taxpayers` money.

Via contracts with two health insurance companies, Council on Aging will work as part of a team of professionals providing coordinated health care and long term care services to low income, frail and disabled adults. The two companies are Aetna Better Health of Ohio and Molina Healthcare of Ohio. They will be serving the five counties of COA`s region, as well as other parts of Ohio.

Statewide, the ICDS will be launched in seven regions covering 29 counties and approximately 114,000 individuals. In our 5 county region, those enrolling in the ICDS are expected to include most PASSPORT clients  more than 2000 people and thousands of others, including adults under the age of 60 with disabilities, and many nursing home residents. The project is expected to launch September 1.

"I am proud that Area Agencies on Aging were chosen to be partners in this new system," said Council on Aging CEO Suzanne Burke. "We have demonstrated our expertise in serving older adults and our success with interventions and services that contain medical and long-term care costs. The ICDS is part of our territory for opportunity that is, the points where health care and long-term care connect. Strengthening those connections in hospitals, physician practices, nursing homes and many other places  is where our future lies."

The ICDS is designed for dual eligibles people eligible for both Medicare and Medicaid because they often require more care than a typical Medicare or Medicaid recipient. According to the Ohio Office of Health Transformation, Ohio`s 182,000 dual eligibles account for just 14% of the state`s Medicaid enrollment, but nearly 40% of total Medicaid spending. In light of the aging population, Ohio must act to contain health care spending. Most of Council on Aging`s PASSPORT home care clients are dual eligibles and will be included in the enrollment process for the ICDS.

The state`s new plan will change the way care is delivered and paid for by better coordinating the long term care, behavioral health and physical health services provided to the plan`s participants. Examples include eliminating unnecessary medical tests, reducing medication errors that can lead to hospitalizations, and connecting people with community based services that help them stay in lower cost care settings, such as their own homes.

The state`s new model of care, is based on several principles:

  • Individuals will receive person centered care through a delivery system designed to address all of their physical health, behavioral health, long term care, and social needs.
  • Individuals will have access to the services they need in the setting they choose.
  • The delivery system will be easy to navigate for both the people receiving services and the providers delivering the services.
  • Individuals will be able to transition seamlessly among settings and programs as their needs change.
  • Incentives in the system will be focused on performance outcomes related to better health, better care, and lower costs through improvement.

Council on Aging will report on progress toward implementation of the ICDS as more information becomes available. To learn more, also visit the Web site for the Office of Health Transformation.

More about ICDS

Who will participate in ICDS?

Individuals who:

  • Receive both Medicare and Medicaid benefits
  • Are an adult with a disability, or
  • 65 years of age or older, or
  • Have a serious mental illness, and
  • Live in one of Ohio`s seven demonstration regions

Features include:

Choice of plan: Eligible individuals may choose from at least two managed care plans operating in their region. In southwestern Ohio, they will choose between Aetna Better Health of Ohio or Molina Healthcare of Ohio.

Medicare opt-out: Individuals may choose to have the ICDS plan provide their Medicare benefits or they may opt out of the Medicare portion of the program. In that case, they may stay with their current Medicare Advantage plan or traditional Medicare. However, the ICDS plan will provide all their Medicaid services.

Enrollment will be in phases, by region, over several months, beginning in summer 2013. Eligible individuals will receive letters explaining the new plan and enrollment procedure. There will be a voluntary enrollment period first. After that, enrollment in an ICDS plan is mandatory. If a person does not enroll in a plan by the mandatory date, Ohio will choose a plan for them. Enrollment will be via phone, online or by mail.