Unique Managed Care Model Improves Quality of Life for People with IDD
New Report Determines Partners Health Plan’s FIDA-IDD Demonstration Shows
Positive Impact and Progress for Enrollees with Complex Care Needs
BRONX, NY, July 6, 2022— Partners Health Plan (PHP), a nonprofit managed care organization dedicated to serving individuals with Intellectual and Developmental Disabilities (IDD), is pleased to announce that the results of an independent evaluation funded by the Centers for Medicare & Medicaid Services (CMS) indicate positive returns for enrollees in the New York Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) demonstration.
The FIDA-IDD demonstration is a pilot program established to test the success of delivering services that address the whole person and promote community involvement and independence for people with IDD eligible for both Medicare and Medicaid benefits. According to the findings, PHP is well on its way toward meeting those objectives.
“This is an extremely positive report,” said Kerry Delaney, CEO of PHP, “but also acknowledges in a realistic way the challenges we have faced.” Those challenges stemmed from the newness of managed care for providers in the space, lack of plan coverage awareness for covered entities, and providers’ refusal to participate or offer services to the population just to name a few. Despite these challenges, key findings reflect that if implemented correctly, managed care can be a viable option to serve people with IDD.”
Key Findings:
- Through the comprehensive “It’s All About Me” (I AM) assessment tool, PHP effectively elicited responses from the IDD population about health and wellness needs allowing enrollees to leverage control over benefit options impacting their everyday lives.
- Innovative solutions like the pharmacy management program reduced errors, unnecessary emergency department visits, and length of hospital stays. Similarly, the telehealth program successfully resolved 90% of consultations virtually. The rewards incentive program “Choose Health” also received positive feedback for motivating members to achieve preventive health goals.
- While the new rate payment method has been a challenge to cover certain member populations, like older and frailer members, programs like pharmacy management are viewed as innovative cost-savings strategies.
- Regularly engaging stakeholders from the Participant Advisory Committee helped to address real-time needs, like improvements to transportation services and communications efforts.
One of the best measures of the impact Partners Health Plan has had on member health and experiences comes from the members themselves. PHP FIDA-IDD plan member, Jessica, stated, “Recently I needed special comprehension therapy for my legs and was able to get something to help me at home. This keeps me healthy and helps my ability to walk. I want to keep my independence. I also have support from my Care Manager and my Broker with my self-direction!”
As the agency responsible for the IDD program in New York State, the Office for People With Developmental Disabilities (OPWDD) was integral in the demonstration’s design and implementation. “OPWDD has been pleased to collaborate with Partners Health Plan on the FIDA-IDD program, which has offered people an opportunity to coordinate their health and long-term care services in a new and innovative way,” said OPWDD Commissioner Kerri Neifeld. “We look forward to continuing to work with Partners Health Plan and the larger provider community to ensure quality supports and services are available to NYers with intellectual and developmental disabilities.”
Read the full report here: https://innovation.cms.gov/data-and-reports/2022/fai-ny-fida-idd-prelim-firstsecondevalrpt.
About Partners Health Plan: Partners Health Plan (PHP) is the first-in-the-nation, provider-led managed care organization that fully integrates Medicare and Medicaid for individuals 21 years and older with intellectual and/or developmental disabilities (I/DD), so they have the most complete care package. PHP provides person-centered care for whole-person wellness addressing the physical, behavioral, and social needs of individuals to assist them in living a quality life. The plan operates in 4 New York State regions (nine downstate counties): New York City, Long Island (Nassau and Suffolk counties), Rockland County, and Westchester County. For more information, visit www.phpcares.org.
About CMS Financial Alignment Initiative: The Centers for Medicare & Medicaid Services (CMS) created the Medicare-Medicaid Financial Alignment Initiatives (FAI) Demonstrations to test in partnership with States integrated care models for dually eligible beneficiaries with the goal to improve care for dually eligible beneficiaries and reduce program costs through an aligned financial and person-centered care coordination structure. A longstanding barrier to coordinating care for Medicare-Medicaid enrollees has been the financial misalignment between Medicare and Medicaid. For more information, visit Financial Alignment Initiative (FAI) | CMS.
