Hearing from Medicare-Medicaid Enrollees: Findings from 2011 Focus Groups

1. Hearing from Medicare-Medicaid Enrollees: Findings from 2011 Focus Groups Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services December 2011

2. Medicare-Medicaid Coordination Office • Section 2602 of the Affordable Care Act (ACA) • Purpose: Improve quality, reduce costs, and improve the beneficiary experience. • Ensure dually eligible individuals have full access to the services to which they are entitled. • Improve the coordination between the federal government and states. • Develop innovative care coordination and integration models. • Eliminate financial misalignments that lead to poor quality and cost shifting.

3. Focus Group Objectives • Gain insight as to how Medicare-Medicaid enrollees make enrollment decisions, including, where available, the decision to enroll in coordinated care. • Learn more about how enrollees experience various types of Medicare and Medicaid service delivery combinations. • Identify language used by enrollees that could improve communication efforts.

4. Focus Group Sites The Dalles WA Portland Milwaukee ME ME Roseburg OR OR MN NY WI WI MA MI CT PA PA Oakland Philadelphia CO Pittsburgh CA CA KY KY NC TN Riverside OK NM NM SC Gallup TX Albuquerque FL

5. Key Site Selection Factors • Service delivery choices available (integrated and separate Medicare-Medicaid combinations). • Medicare-Medicaid enrollee sub-populations reachable. • Local partners willing to assist. • Opportunity to contribute to demonstration planning.

6. Participants • 156 people in 21 groups. • Mostly 18-64 years (3 groups were 65+). • Persons with physical disability, serious mental illness, developmental disability, multiple chronic illnesses, LTSS need, and “no particular condition” were all represented. • One Chinese speaking group. • One group with Navajo majority.

7. Knowledge of Medicare and Medicaid • Wide variation in participants’ understanding of Medicare and Medicaid differences. • Some could detail the differences with great accuracy and specificity including that Medicare is the primary payer. • Many associated Medicare with hospital coverage and some knew Medicaid covers long-term supports and services. • Others only knew that they were separate programs.

8. Enrollment Choices • Most participants could not recall how they had come to have their current Medicare and Medicaid service delivery options. • Several said it had “just happened automatically.” • Some said they had been advised to join a particular plan by a doctor, case worker, friend or family member. “I’d like to be on [the combined plan], but my psychiatrist won’t take it, so I have to stay on straight Medicare.”

9. What do Medicare-Medicaid Enrollees look for? • Physician and/or psychiatrist in network. • Benefits: • Dental and eye care • Transportation • Prescription drugs • Persons with physical disabilities cited DME and personal care • Cost (low/no premium and copays). • Familiarity. • Streamlined benefits administration.

10. How would Medicare-Medicaid Enrollees like to receive information? • Written information that simply states what is covered, what is not, and the cost. • Up-to-date provider directories (including whether or not taking new patients). • Navajo participants asked for in-person meetings, in their language, on the reservation. • Most participants cited poor access to the Internet and frustration with automated phone information. “Well they can be quite overwhelming, you know. You don’t understand what they’re offering.”

11. What Medicare-Medicaid Enrollees Want in Doctors • Taking the time needed at appointments. • Listening. • Explaining things in simple language. • Being able to get an appointment or to talk to the PCP on the phone. “[My doctor] listened to me. He made sure that whatever concerns I had or whatever he thought it was that I needed to take care of, he took care of.”

12. Transitions • Persons with serious mental illness experienced particularly poor communication between hospitals and their community teams. • Participants reported being discharged with new medication, and follow-up instructions that did not reference their community teams.

13. Coordination of Care vs. Coordination of Benefits • Participants were much more focused on coordination of benefits than coordination of care. • Coordination Of Benefits • Coordination of benefits issues included balance billing, difficulty getting authorization for service, and “getting the run-around” between Medicaid and Medicare. • Participants in integrated programs expressed much greater satisfaction with coordination of benefits than those is separate programs. • Coordination of Care • Participants who did not belong to combined plans more frequently reported multiple people helped them with care coordination. • Participants in combined plans more frequently reported single-points of contacts that could help resolve problems/access care. “In regards to having a problem…you have to call both numbers to get it resolved. And I was thinking, it would be just so nice if I could call one number and have it resolved.”

14. Medicare-Medicaid Enrollee Language

15. Policy Relevance • Overall • Need for greater person-centered care coordination that crosses all aspects of care rather than in a compartmentalized way. • Important not to forget to look at how Medicare-Medicaid enrollees experience care at the front end (e.g., member materials, insurance cards, point of contacts, etc.) and other administrative issues. • CMS/MMCO • Support/refine ongoing work to improve quality and experience of care for Medicare-Medicaid enrollees • Alignment Initiative • State demonstration design • Improve how CMS directly communicates with enrollees (e.g., use language that will better resonate, simplify materials, etc.)

16. Questions & Suggestions: MedicareMedicaidCoordination@cms.hhs.gov For more information, visit: http://www.cms.gov/medicare-medicaid-coordination/