Earlier this month, I introduced readers to Mrs. S., who was in danger of becoming bedbound by her arthritis, congestive heart failure and diabetes. But as a result of team care through an integrated home health program for a highly vulnerable population, Mrs. S. now gets out of bed each day, makes her way to the kitchen and living room through the morning, and even takes short walks inside and outside her apartment building, greeting her neighbors along the way.
She is living a fuller life than she might otherwise have thanks to the Fully Integrated Duals Advantage program, or FIDA -- so called because those who benefit are dually eligible for Medicare and Medicaid. This innovative program, a step in the right direction for healthcare reform, recently got a new lease on life in New York State, where enrollment had been languishing and the program's future was in question.
The New York Department of Health and the Centers for Medicare & Medicaid Services, which jointly launched FIDA nearly a year ago, approved several changes to the program this month that are expected to increase flexibility, reduce barriers to entry and operation, and ultimately increase enrollment. This is an important move in our nationwide effort to support this vulnerable -- and costly -- health care population: elderly Americans with multiple chronic illnesses who require long term health support services and depend on both Medicare and Medicaid.
The FIDA program rolls all the benefits of Medicare and Medicaid into a single comprehensive plan, meaning that one insurance card and one phone number connects participants to access and assistance with their needs, including doctor visits, hospitalizations, behavioral health, long-term care services and supports, social services, and prescription drugs.
Each person's care needs are overseen by a single skilled and dedicated care manager, who is in frequent dialogue with an Interdisciplinary Care Team (IDT) of providers, who, together with the participant, create a path to better health.
One key revision to the program relaxes the steep requirement for primary care doctors to train in and be a formal part of the IDT (Interdisciplinary Team), a burdensome regulation that many stakeholders felt was limiting enrollment.
Now, primary care providers can participate on a case-by-case basis, depending on an enrollee's needs and care plans. Specifically, as outlined in the NY State Summary of FIDA Reforms, the revised FIDA plan allows for a "Participant's right to choose members of the Interdisciplinary Team (the team can be small, with just the participant and care manager, or broader, with a variety of members from the original IDT list)," as well as:
More Flexible IDT
- Provider participation in an IDT is adjustable, depending on member availability, items being discussed in a given meeting, or the needs, wishes, and goals of the Participant.
- Primary Care Providers may review and sign off on a completed Person Centered Service Plan (PCSP) without attending IDT meetings.
- IDT members may meet at different times. The Care Manager may separately meet with different IDT members in developing the PCSP.
- Plans have authorization over any medically necessary services included in the PCSP that are outside of the scope of practice of IDT members.
- IDT training will be encouraged, but not mandatory.
Simplified procedures
- Plans and IDTs have more flexibility in how and when the IDT members communicate with one another.
- Plans retain responsibility for effective and efficient information sharing among providers (including non-IDT members), including any PCSP revisions.
Ease of transition and timing of assessments
- Plans may use the existing MLTC schedule for completion of a Participant´s Uniform Assessment (UAS) if the Participant is transferring from a sister MLTC/PACE/MAP plan; i.e., each FIDA enrollee transferring from a sister plan need not complete a new assessment until six months from the date of their last MLTC assessment.
- The FIDA Plan must contact the Participant and review any available medical record and claims history from the pre-enrollment period to determine changes in health status, health event, or needs that would trigger an updated UAS.
- If an updated UAS is required, it will be conducted within six months of the last UAS, and development of PCSP implemented within 90 days following the enrollment effective date.
- All other Participants have a PCSP deadline of 90 days from the enrollment effective date.
"DOH has simplified the mechanism for information sharing," says Natachia Ramsay, Director for FIDA Product Management at VNSNY CHOICE. "Primary care providers will still know what is going on with the participant and the care plan, but now, with this change, the participant and the plan's FIDA care manager can have a direct conversation about care needs, identify barriers to care, reconcile medications if necessary, and identify additional services to keep the participant safe in the community." Natachia notes that our organization refers to those enrolled in the FIDA plan as participants, rather than members or patients, because they, in direct dialogue with their care managers, are active participants in their day-to-day health care.
Another change calls for allowing health plans more freedom in how they reach out to FIDA-eligible New Yorkers, educating and informing them of their health plan options. This, too, is expected to improve enrollment, as DOH has said it believes that FIDA's underperforming enrollment is due, in part, to potential participants being unclear on how FIDA could benefit them above and beyond their current plan.
At VNSNY CHOICE, we have already seen FIDA bring so many encouraging improvements in quality of life and quality of care for elderly New Yorkers struggling with chronic health issues, behavioral health issues, and environmental conditions that exacerbate illness. Through the program, we have helped a grandfather with congestive heart failure relocate to a lower-floor apartment so he didn't become homebound in a fourth-floor walk-up. We have helped Mrs. S., whose neighbors mean the world to her, interact with them on a daily basis. And we hope to help thousands of other elder New Yorkers breathe easier and live better in 2016.
While the FIDA program continues to be refined, there is no question that its integrated approach represents the health care model of the future.