Hawaii Department of Human Services, Med-QUEST Division in Partnership with ATI Advisory
Hawaii has incrementally pursued program improvements for dual-eligible individuals over the past several years, including the establishment of five Highly Integrated Dual Eligible Special Needs Plans (HIDE SNPs) that cover most of the state. This project under the Advancing Medicare & Medicaid Integration initiative seeks to make meaningful advancements in the design of Hawaii’s integrated care program with a focus on developing a state strategy for implementing improved care coordination, data analytics, and benefit counseling for dual-eligible individuals.
With support from Arnold Ventures, Hawaii is working with ATI Advisory to advance integration through various activities, including: (1) enhancing the Dual Eligible Special Needs Plan (D-SNP) platform; (2) improving care coordination for specified dual-eligible populations; and (3) increasing an understanding of the Medicare fee-for-service population (FFS) to inform Medicaid managed long-term service and support (MLTSS) program design.
To achieve its objectives, Hawaii and ATI Advisory are undertaking a 36-month effort that includes:
- Enhancement of Hawaii’s D-SNP platform: ATI Advisory will work with Hawaii to develop a strategy and implement policies to build out a new Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) program, while also further refining the HIDE SNPs currently available. The new FIDE SNP program will be available in 2024 and provide a more integrated member experience, including integrated member materials (e.g., a single identification card, provider directories), streamlined assessments, and enhanced quality oversight. Hawaii will further advance integration in its HIDE SNPs through contract requirements around model of care design and quality priorities.
- Care coordination improvements for all dual-eligible individuals, including populations not participating in MLTSS: Hawaii and ATI Advisory will implement data sharing strategies with D-SNPs to support better care coordination for populations not enrolled in MLTSS. The Hawaii team will also work to develop an implementation strategy for the state’s All-Payer Claims Database related to using D-SNP data to support care coordination for dual-eligible populations and management and oversight of integrated care programs in the state.
- Increased understanding of the Medicare FFS population to inform MLTSS program design: ATI Advisory will conduct data analyses to understand the Medicare FFS populations, including analysis of utilization data and transitions of care opportunities. The analyses will provide a baseline of key trends among these populations to inform potential MLTSS program design. Data findings will also inform State Health Insurance Assistance Program assisters and other stakeholders to better educate beneficiaries about enrollment in integrated care options.
Support for Other States
Many states are in the same position as Hawaii ― they know that they want to improve care for their dual-eligible populations, but they face resource gaps that prevent them from moving forward. Arnold Ventures launched the Advancing Medicare & Medicaid Integration initiative for this very reason and is currently accepting applications from states seeking to improve care for dual-eligible populations.
Project Key Facts
- Grantee: Anne Tumlinson Innovations (ATI) Advisory
- Partner: Hawaii Department of Human Services, Med-QUEST Division
- Project Period: July 2022 – July 2025
- Award Amount: $632,522
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