Slide 1: One Care:  Implementation Council Meeting
Executive Office of Health & Human Services
MassHealth Demonstration to Integrate Care for Dual Eligibles
September 8, 2020, 10:00 AM – 12:00 PM
Virtual Meeting via Zoom
Slide 2: MassHealth Presentation
•	Plan Engagement with My Ombudsman
•	Comprehensive Assessment, MDS-HC Assessment, and Individualized Care Plan Requirements
•	Assessments Completion, Care Plan Completion, and Annual Flu Vaccination Data
•	Plan-reported COVID-19 data - Integrated Care Programs
Slide 3: My Ombudsman Scope of Services
My Ombudsman helps resolve Members' issues and concerns in a variety of ways.
•	My Ombudsman:
o	Provides information. My Ombudsman answers questions about MassHealth health plans, including information about specific benefits, Member rights, and how to access services.
o	Investigates. My Ombudsman talks to all parties to understand concerns, discuss options, and build solutions.
o	Mediates. My Ombudsman can bring together people who want to solve problems.
o	Discusses options. My Ombudsman can help individuals find and consider options for addressing their concerns.
o	Explains Grievance/Appeal process. My Ombudsman can work with Members and their Plan to try to resolve a concern before filing a Grievance or Appeal. While My Ombudsman cannot represent a Member in Grievance or Appeal proceedings, staff members can explain how to file an Appeal and what to expect during the Appeal process.
o	Makes referrals. My Ombudsman can refer individuals to information and problem resolution resources, including formal Grievance and Appeal processes and legal services.
•	My Ombudsman stays neutral:
o	My Ombudsman staff will not judge or decide who is right or wrong or make decisions.
o	My Ombudsman will not serve in any other role that would compromise their ability to be impartial.
o	My Ombudsman will not represent a Member in a Grievance or Appeal proceeding.
Additional information can be found at: MyOmbudsman.org
Slide 4: My Ombudsman Three-way Contract Summary of Requirements (See Section 2.5.8.6.)
Plans are required to support Member access to, and work with, the Ombudsman to address Member and eligible beneficiary requests for information, issues, or concerns related to One Care, including: 

•	Educating Members about the availability of Ombudsman services:
o	On the Plan’s website 
o	When Members receive the Member Welcome package when they join One Care
o	At the time of the annual Comprehensive Assessment
o	When Members – or their family or representatives – contact One Care plan staff, including member services and provider staff, with a Grievance or Appeal

•	Communicate and cooperate with Ombudsman staff as needed for them to investigate and resolve Member requests for information, issues, or concerns related to One Care, including: 
o	Designating a staff person as the Plan’s Ombudsman liaison, who shall work with the Ombudsman to resolve issues raised by Members 
o	Providing Ombudsman staff with access to records needed to investigate and resolve complaints (with the Member’s approval)
o	Ensuring ongoing communication and cooperation of Plan staff with Ombudsman staff in working to investigate and resolve Member complaints, including updates on progress made towards resolution, until the complaints have been resolved

See in April 1, 2019 Massachusetts Contract for One Care Plans.
Slide 5: Comprehensive Assessment: Three-way Contract Summary of Requirements (See Section 2.6.1)
•	The purpose of the Comprehensive Assessment is for the Plan and the Member to engage in a person-centered process to understand the Member’s needs and goals and to support development of the Member’s care plan
•	Complete within 90 days of each Enrollee’s enrollment date, and within the Continuity of Care period
•	Complete at least annually thereafter, as well as whenever an Enrollee experiences a major change
•	Includes completion of an assessment tool (can be Plan-developed tool); informed by at least one in-person meeting covering required domains as appropriate for Enrollee to inform care plan
•	The Member will be at the center of the assessment and care planning process. The Plan will ensure that the Member receives information about the Comprehensive Assessment, any necessary assistance and accommodations to prepare for and fully participate in the Comprehensive Assessment, the right to initiate Service Requests, and how to request access to the Comprehensive Assessment. 
•	The Plan will complete the Comprehensive Assessment in a location that meets the needs of the Member, including home-based assessments as appropriate. With the Member’s consent the Plan will also gather information from the Member’s providers or other sources of support. 
•	May be done at the same time as the MDS-HC assessment, or at a different time

See in April 1, 2019 Massachusetts Contract for One Care Plans.
Slide 6: MDS-HC Assessment: Three-way Contract Summary of Requirements (See Section 2.6.2)
•	The purpose of the MDS-HC is to support assignment to a Rating Category to inform capitated payments from MassHealth to the Plan
•	The MDS-HC must be completed in-person by a registered nurse 
•	Information collected on the MDS-HC must be sent to MassHealth
•	The MDS-HC can be incorporated into the Comprehensive Assessment or it can be completed separately
•	For individuals in the C1 Rating Category, the MDS-HC is only required to change the Rating Category
•	The MDS-HC must be completed for all other individuals in the community, based on time standards in the Contract

See in April 1, 2019 Massachusetts Contract for One Care Plans.
Slide 7: Individualized Care Plan (ICP): Three-way Contract Summary of Requirements (See Section 2.6.3.)
•	Incorporate the results of the Comprehensive Assessment and specify any changes in providers, services, or medications
•	Be developed by the care team under the direction of the Member, and in consultation with any specialists caring for the Member, and updated periodically to reflect changing needs identified in Comprehensive Assessments
•	The Member will be at the center of the care planning process
•	Reflect the Member’s preferences and needs. The Plan must ensure that the Member receives any necessary assistance and accommodations to prepare for and fully participate in the care planning process, including the development of the ICP, and that the Member receive clear information about:
o	Their health status
o	How family and social supports can be involved in care planning as the Member chooses
o	Self-direct care options and assistance available to self-direct care
o	Opportunities for educational and vocational activities
o	Available treatment options, supports and/or alternative courses of care
•	Describe how services and care will be integrated and coordinated among providers
•	The Enrollee has the right to sign or otherwise convey approval of their care plan when it is developed and when it is changed
Slide 8: Comprehensive Assessment Completion within 90 days of Enrollment – CY 2019-2020
Percentage of Completed Comprehensive Assessments 
Calendar Quarter of Members' Enrollment
Q2 2019	CCA 67%, Tufts 77%
Q3 2019	CCA 79%, Tufts 75%
Q4 2019	CCA, 64%, Tufts 38%
Q1 2020	CCA, 68%, Tufts 59%
Q2 2020*	CCA,74%, Tufts 19%

Unable to Locate
Q2 2019	CCA 17%, Tufts 20%
Q3 2019	CCA 12%, Tufts 21%
Q4 2019	CCA, 20%, Tufts 56%
Q1 2020	CCA, 17%, Tufts 31%
Q2 2020*	CCA,17%, Tufts 70%

Small variation in unreachable members between the Comprehensive Assessment and ICP may indicate a change in unreachable status

The percent of assessed members is the sum of individuals with enrollment dates in the quarter who were assessed within 90 days after their enrollment, divided by the sum of individuals with enrollment dates in the quarter who were still enrolled in 90 days.
*Q2 2020 represents data from April and May only
Slide 9: Core 2.3 - Individualized Care Plan Completion within 90 Days of Enrollment – CY 2019
Percentage of completed ICP

Q1 2019	CCA 69%, Tufts Unify 86%
Q2 2019	CCA 65%, Tufts Unify 78%
Q3 2019	CCA, 76%, Tufts Unify 82%
Q4 2019	CCA, 65%, Tufts Unify 41%

Unable to Locate
Q1 2019	CCA 22%, Tufts 12%
Q2 2019	CCA 18%, Tufts 17%
Q3 2019	CCA, 11%, Tufts 19%
Q4 2019	CCA, 27%, Tufts 54%

Small variation in unreachable members between the Comprehensive Assessment and ICP may indicate a change in unreachable status
Slide 10: Annual Flu Vaccination One Care Plan Reporting
One Care Plans are required to report the rate of Annual Flu Vaccination for Members through the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. 

Annual Flu Vaccinations - CAHPS reporting for One Care Plans

Percentage of Enrollees Reporting

2016
Commonwealth Care Alliance	71%
Tufts Unify	72%
National MMP Plans	65%
National Medicare and Advantage Plans	74%

2017
Commonwealth Care Alliance	73%
Tufts Unify	70%
National MMP Plans	65%
National Medicare and Advantage Plans	73%

2018
Commonwealth Care Alliance	65%
Tufts Unify	60%
National MMP Plans	66%
National Medicare and Advantage Plans	75%

2019
Commonwealth Care Alliance	69%
Tufts Unify	61%
National MMP Plans	67%
National Medicare and Advantage Plans	74%
Slide 11: Plan-Reported COVID-19 Cases and Deaths – Integrated Care Plans
For discussion purposes only – this data is plan-reported, unofficial, and preliminary
Integrated Care Plans- COVID Positive Cases and Deaths

One Care (Ages 21-64)
8/1 Enrolled – 28,356
	Positive Cases 572(2.0%)
	Deaths 37(0.1%)

PACE (Ages 55+)*
8/1 Enrolled = 4,694
	Positive Cases 736(15.7%)
	Deaths 199(4.2%)

SCO (Ages 65+)
8/1 Enrolled = 65,197
	Positive Cases 3,434(5.3%)
	Deaths 675(1.5%)

Morbidity & Mortality Rate (per 100K pop.) for Integrated Care Plans

Morbidity
One Care	2,013.7
PACE	15,679.6
SCO	5,267.1

Mortality
One Care	130.5
PACE	4,239.5
SCO	1,035.3
*All PACE participants are at a Nursing Facility Level of Care
The above graph displays the cumulative number of positive cases and deaths of Enrollees in Integrated Care Plans through August 31, 2020. Percentages are cases divided by August 1, 2020 enrollments.
Slide 12: Plan-Reported Monthly COVID-19 Cases and Deaths – Integrated Care Plans
For discussion purposes only – this data is plan-reported, unofficial, and preliminary

IC Plans- Monthly COVID Positive Cases and Deaths

Total Membership (n) as of August 1, 2020
One Care – 28,356
PACE – 4,694
SCO – 65,197

Note: the following information was shown on a line chart. In some case, the numbers for July and August were not readable on the chart, and therefore, are not listed.

April - August 2020
PACE Positive Cases - April: 523  May: 131 June: 20 July: --  August: --
PACE Deaths - April: 95  May: 50  June: 10  July: 8  August: --

One Care Positive Cases - April: 280  May: 162 June: 62 July: -- August: --
One Care Deaths - April: 17  May: 15  June: 3 July: -- August: --

SCO Positive cases - April: 2000  May: 964  June: 275  July: 72 August: 36
SCO Deaths - April: 351 May: 240  June: 51  July: 19 August: 7
Slide 13: One Care
MassHealth+Medicare
Bringing your care together
VISIT US ONLINE
www.mass.gov/one-care

EMAIL US 
OneCare@state.ma.us