Washington MFFS Preliminary Evaluation Report

By Patrick Conway, M.D., CMS Principal Deputy Administrator and Chief Medical Officer

Today we released a report summarizing preliminary results from the Washington Health Homes demonstration under the Medicare-Medicaid Financial Alignment Initiative. This demonstration, which began serving enrollees in July 2013, seeks to leverage Medicaid health homes to improve service quality and integration while reducing costs of care for high-risk, high-cost Medicare-Medicaid enrollees (sometimes referred to as “dual eligibles”) in Washington State.

More than 10.7 million Americans are enrolled in both the Medicare and Medicaid programs. A longstanding barrier to improving quality and reducing costs of care for Medicare-Medicaid enrollees has been a lack of alignment and cohesiveness between the two programs, including misaligned incentives for payers and providers. The Washington Health Homes demonstration tests new mechanisms to coordinate services across Medicare and Medicaid for Washington State Medicare-Medicaid enrollees, and allows the State and the Federal governments to share in savings resulting from quality improvements.

The preliminary results in this report are based on experience during the first demonstration performance period, from July 2013 – December 2014. Despite the relatively short time period, estimates show a reduction of $21.6 million in Medicare spending relative to a comparison group, representing more than 6% savings.  Future analysis will include Medicaid spending estimates as the data become available.

The report also includes early quality and utilization results, eligibility and enrollment data, characteristics of the population eligible for the demonstration, beneficiary focus group findings, and a discussion of the initial implementation experience.

While these findings are preliminary, they provide an encouraging first look at how efforts in Washington to improve quality of care by focusing on the needs of high-risk, high-cost members can reduce Medicare spending.

The first annual evaluation report on the Washington demonstration, scheduled for a 2016 release, will include additional information on the context and status of the demonstration, as well as analyses of quality, utilization, and cost measures for Medicare-Medicaid enrollees eligible for the demonstration and for a comparison group.

This model further supports delivery system reform aimed at achieving better care, smarter spending, and healthier people.  It is especially important to focus on the safety net population served by this model in order to reduce disparities and coordinate care for vulnerable populations.

This report is posted on the CMS website: https://innovation.cms.gov/initiatives/Financial-Alignment/

Additional information about the Washington Health Homes demonstration is available on the Medicare-Medicaid Coordination Office website: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Washington.html

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