The initial figures on how many Medicare-Medicaid dual eligibles are opting out of joint CMS-state demonstration programs are even higher than expected. In Massachusetts, for instance, state data show a 1.54 ratio of total opt-outs to enrollments as of April 1. In San Mateo County, Calif., for a period concluding on the same date, state data show a 28.9% opt-out rate among eligible duals passively enrolled into health plans. Rates of this magnitude, which also may occur in some state duals programs, could severely reduce expectations for cost savings from the initiatives, and lower the potential for true care integration. What is behind the high opt-out rates? What can be done to improve poor rates within the regulatory constraints? Hear all the details from three experienced duals plan executives.
The On-Demand recording will be available immediately upon purchase* as a link within a PDF file of the accompanying written materials. CDs and printed materials are shipped via USPS.
Experts had projected high opt-out rates for duals demo programs, given the difficulties of serving this vulnerable population. But the initial figures are considerably higher than anticipated … and both federal and state rules hamper what can be done to reduce opt-outs. With the tight financial environment these programs operate in, high opt-out rates can mean the difference between failure and success.
Hear three health plan executives with years of direct duals experience assess what is causing the high opt-out rates, how to evaluate and monitor them, and what can be done to prevent them. You’ll get answers to questions such as:
TOM STANDRING is vice president, Medicare at Molina Healthcare, Inc. In this role, Mr. Standring serves as general manager of the company’s Medicare operations and Medicare lead for its emerging Medicare-Medicaid plans in several states. His responsibilities include Medicare Parts C and D, compliance, sales, quality and risk adjustment. An attorney, he joined Molina’s legal department in 2005 after practicing with health care law firm Epstein Becker & Green. Mr. Standring also is a certified public accountant and started his career at Ernst & Young.
SONJA BREHM is vice president, health plan services for Fallon Total Care in Worcester, Mass. She is responsible for managing the performance and operations of its One Care CMS-backed program for Medicare-Medicaid dual eligibles. Before that, Ms. Brehm managed the Medicare Advantage and commercial product portfolios at Fallon Community Health Plan. Ms. Brehm joined Fallon in 1999 after leading the implementation of the sales system at Glatfelter Insurance Group in York, Pa.
TOM LUTZOW, Ph.D., is president and CEO of Independent Care Health Plan (iCare), a duals plan that is a joint venture between Humana Inc. and a local Milwaukee rehabilitation agency. Dr. Lutzow was an original architect of this initiative that started in 1992, has served on its board of directors since inception, and became president and CEO in 2008. iCare operates a dually eligible Special Needs Plan with more than 5,000 members and is an integral part of the Wisconsin Family Care Program for long-term care.
Moderator: Jim Gutman, managing editor of AIS's Medicare Advantage News
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