By Steven Syre
Researchers found that consumer advisory councils at Medicare-Medicaid Plans focused most on member benefits, coordination of care, and delivery of services.
Talking helps.
New research by Community Catalyst’s Center for Consumer Engagement in Health Innovation examined the influence of consumer advisory councils (CAC) that assist certain health plans serving people who are eligible for both Medicare and Medicaid. The study found that advisory councils influenced the way those plans conduct member outreach, and the way they structure or deliver benefits.
The research was based on surveys of 35 Medicare-Medicaid Plans (MMP) participating in a government initiative, as well as interviews with health plan representatives, consumers, consumer advocates, and officials at the Centers for Medicare & Medicaid Services (CMS).
The study found that 79% of MMPs reported that CAC deliberations changed communication or member outreach. Member benefits or enrollment were impacted at 42% of the plans. Other significant CAC contributions included enhancing membership education, addressing the social determinants of health, switching transportation vendors, and changing care coordination policies or practices.
IMPROVING CARE AND SERVICES FOR THE DUAL ELIGIBLE POPULATION
About 10.7 million Americans are dually eligible for both Medicare and Medicaid benefits. These beneficiaries are typically older adults with low incomes or people with disabilities who tend to have complex health and social needs and account for a disproportionately high share of costs for both programs.
CMS launched the Financial Alignment Initiative in 2011 to improve health outcomes among dual eligible individuals and stabilize costs. The initiative was designed to fix financial misalignment between Medicare and Medicaid by improving care coordination and integration between the 2 programs.
Thirteen states opted to participate in the initiative and most implemented a capitated plan to provide comprehensive and coordinated care. About 390,000 dual eligible individuals are now enrolled in such plans. All the participating plans were required to establish consumer advisory councils. The new study focused on consumer councils formed by MMPs in states that opted to participate in the initiative.
The report was co-authored by Marc Cohen, co-director of the LeadingAge LTSS Center @UMass Boston, along with Rachel Isaacson, Leena Sharma, and Renee Markus Hodin of Community Catalyst. Cohen is also research director at the Center for Consumer Engagement in Health Innovation at Community Catalyst, where Hodin, an LTSS Center fellow, is the deputy director.
HOW CONSUMER ADVISORY COUNCILS PERFORM
There were some suggestions from consumer advocate interviewees that MMPs operate their CACs solely to fulfill contractual obligations. However, the report suggests that this was not the case for most plans.
“Our research found that the vast majority of plans operate CACs with respect for the value they provide for both the plan and their member body,” the authors write. “Representatives from several MMPs stated that a desire to elevate the consumer voice in their operations was at the core of why and how they operate their CAC.”
The report also concluded that:
- Member benefits were the most common agenda topic at CAC meetings. Care coordination and access to health services were the next most common topics.
- CACs most commonly communicate with MMP leadership by sharing feedback at senior staff meetings. MMP leaders most commonly communicate with their CAC through plan representatives or by attending council meetings and sharing information in person.
- The most common challenge MMPs face as they operate CACs involved enrollees who wanted to discuss personal issues rather than agenda items. Difficulty recruiting and retaining enrollees were other common challenges.