Briefs & Reports

Integrated Care for Dual Eligibles

In previous editions of The Michigan Update we have written about Michigan’s plan to implement an integrated delivery system of health care for persons dually eligible for Medicare and Medicaid. DCH submitted a proposal to CMS in April 2012, which CMS posted for public comment. Based on questions and comments from CMS, the department has been working on refinements to the proposal that provide more operational detail since that time.

There are several issues that require more detailed development, one of which relates to the coordination of physical and behavioral health care. The proposal would continue separate contracts, using risk-based reimbursement, with Prepaid Inpatient Health Plans (PIHPs) for behavioral health services and with Integrated Care Organizations (ICOs) for acute and long-term care. The submitted proposal would utilize a “Care Bridge” model to bring coordination and accountability between the PIHPs and ICOs.

A Care Bridge is a care coordination framework designed to identify and stratify populations based on dominant need; the dominant need may be for behavioral health, intellectual or developmental disability services, for long-term care or special supports due to aging or a complex medical condition, or the individual may be “flagged” for an assessment to determine the dominant need if past service utilization is not telling. The Care Bridge is designed to assess and develop integrated and individualized (person-centered) care and supports plans that ensure a linkage to health and community services and supports; and the Care Bridge monitors the plans and occurrence of trigger events requiring plan modification. Although an individual’s care coordination team will be multidisciplinary and assure a focus on the dominant need, each individual will select a team leader who will serve as their primary contact.

There is also an issue related to region configuration. The current geographic regions used for the Medicaid Health Plan and the PIHP contracts are different, so there is discussion regarding changes to one or both of these regional configurations for consistency. In addition, the appropriate number of regions for the duals demonstration may be smaller than for either Medicaid Health Plan or PIHP contracting.

For more information, contact Eileen Ellis, Managing Principal, at (517) 482-9236.