Though it’s still too early to get concrete results on the success of CMS-backed dual-eligibles demonstrations, health plans willing to make sizeable investments in caring for the duals population have already begun to see positive outlooks for future savings, including successful living transitions from nursing facilities to a home-based setting.

“We’ve already been able to achieve success in transitioning members from institutional settings back into the community,” Anthony Evans, vice president of integrated services at CareSource Management Group Co., said in an interview with AIS. “The costs are much lower for home and community-based services. Those are some pretty early indicators [of savings].”

CareSource operates a managed care plan within MyCare Ohio, the third Medicare-Medicaid alignment demonstration to receive CMS approval. The program officially launched in May 2014 and has a total opt-in enrollment of 63,446, according to DUAL’s May 20 update. DUAL counts an additional 12,308 Ohio duals covered through Dual-Eligible Special Needs Plans or PACE plans.

DUAL currently counts 15,172 MyCare Ohio enrollees in CareSource, 23.9% of the Ohio program. In addition, the state of Ohio reports approximately 7,400 dual opt-outs receiving Medicaid-only services through CareSource. The Ohio demo requires all duals to receive Medicaid services through a contracted managed care plan, but beneficiaries can opt out to continue receiving Medicare coverage through fee-for-service or another Medicare Advantage plan.

Evans said about 50% of CareSource’s dual members are eligible for nursing and other long-term care facilities (with 25% currently receiving institutionalized care), and outreach is critical to ensuring these members experience improved health outcomes. This effort requires significant financial investment, particularly in hiring hundreds of new staff members and supporting new technology.

“We’ve on-boarded close to 400 care management staff, which consists of care management teams, internal staff and contracted delegates,” Evans said. “We’ve made substantial investments in technology, such as system enhancements for care management and claims, particularly around the ability to authorize and pay for long-term care services. We didn’t have the ability to do that before the duals program launched.”

Each dual member participating in the Ohio demo is assigned a care manager, a single point of contact within the health plan who assists beneficiaries in managing their new services. Evans cited this relationship as crucial to the demo’s success and a key element of receiving feedback from the dual population.

“The immediately accessible point of contact to help them navigate the system is a huge improvement over fee-for-service,” he said. “We hold quarterly consumer council meetings in both community settings and in the institutional facilities and nursing homes where we have membership, so they can provide feedback and connect with their care manager.”

Though Evans said he isn’t sure the three-year span of the demonstration will be long enough to determine whether the program is sustainable, CareSource is already achieving its goal of giving duals the advocacy to navigate their care plan.

“The demos are in the process of defining a model,” he said. “It’s going to take some time to try and perfect that, but duals are already experiencing a more cohesive system.”

© 2015 by Atlantic Information Services, Inc.

This article has been updated from a previous version to clarify that while 50% of CareSource's dual members are eligible for institutionalized care, only 25% are currently residents of nursing and other long-term care facilities.