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Connections - 07.29.22

Fully Integrated Duals Advantage for People with I/DD: An Evaluative Update

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by Tyler Blake, MediSked

The first and only “fully integrated duals advantage” (FIDA) Medicare-Medicaid Plan (MMP) in the United States exclusively serving people with intellectual and developmental disabilities (I/DD) was launched in early 2016 in New York as a demonstration program under the Centers for Medicare & Medicaid Services (CMS) “Financial Alignment Initiative.” The idea behind this initiative is to test different integrated care models for dually eligible beneficiaries, such as individuals who are eligible for both Medicaid and Medicare benefits.

The main goals behind FIDA are to increase health care access and to organize care around the unique needs of this population, as historically the dually eligible population has had some of the most unique, complex, and costly long-term care needs of Medicaid or Medicare-eligible populations.

In this particular program, unique to New York, eligible beneficiaries included individuals aged 21 or older eligible for both state developmental disability services as well as Medicare services, with a level-of-care need of that provided by an intermediate care facility.

Now that the demonstration has been running successfully for several years, CMS has released its first preliminary evaluation report on the FIDA-I/DD demonstration, with the aim to evaluate the impact of the demonstration program on beneficiary experience, quality of care, utilization of care, and cost. The findings, while preliminary, have provided some encouraging takeaways. Some of the key evaluation takeaways are explained below.

1. Comprehensive Care Management and Assessment

Throughout the demonstration, stakeholders including enrolled beneficiaries have perceived the model of care management used by the MMP as “uniquely comprehensive, providing individuals with a level of control over a wide range of detailed choices impacting their everyday lives.” Additionally, the comprehensive “It’s All About Me” (I AM) assessment has been successful in identifying social, functional, behavioral, medical, and wellness needs from I/DD population served as part of the demonstration.

2. Enhanced Beneficiary Experience

The report found that the flexible benefit package offered by the MMP was able to be used in novel ways, to specifically help meet the population’s needs as identified as part of the I AM assessment. Telemedicine has also been effectively used to reduce unnecessary and disruptive doctor and emergency department visits. This helped to meet the population’s needs during the COVID-19 pandemic.

3. Quality of Care

As a result of the pharmacy management program provided by the MMP, which reviewed medications across all enrolled beneficiaries’ providers, overall emergency department visits and hospitalizations due to medication management issues decreased. The reduction in hospitalizations was also identified as a potential source of cost savings.

While there are areas for improvement, including low overall enrollment numbers due to a voluntary opt-in enrollment model, preliminary findings of the demonstration show some encouraging results. In 2020, New York and CMS announced the extension of the FIDA-I/DD demonstration through December 31, 2023.

A central aspect of the FIDA-I/DD demonstration is the provision of comprehensive care coordination for all enrolled beneficiaries. The first and only FIDA MMP exclusively serving individuals with I/DD, Partners Health Plan (PHP), uses the MediSked Care Coordination Suite to record data, examine trends, and ensure compliance. Read more about why PHP selected the MediSked Care Coordination Suite as its software solution and the results in this blog by Karleen Haines, Chief of Community Relations and Outreach at PHP.

Tyler Blake, Esq. is the Privacy Officer at MediSked, LLC and has been with the company for over four years. His work focuses on industry research and maintaining regulatory compliance with state and federal laws such as HIPAA and HITECH, as well as analyzing, drafting, and implementing new policies to ensure MediSked’s continued compliance for the clients we serve.