New York Joint Venture Focuses on Dual Qualifying Special Needs Population

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Like a recent Health Affairs article noted, states such as New York and California are increasingly leveraging their ability to improve coordination and integration between Medicare and Medicaid through Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs). In a recent interview, executives from insurer MVP Health Care and D-SNP-focused startup Belong Health talked about their New York joint venture, which launched in 2022.

Special Needs Plans (SNPs) are a type of Medicare Advantage plan focused on critical care coordination and designed for people with special needs. D-SNP health plans provide the opportunity to break down care silos by allowing care managers to be in regular contact with members and their health care providers, enabling a more coordinated approach to meeting health needs. physical, behavioral and social of a member.

Philadelphia-based Belong Health was started by people with expertise in Medicare Advantage and SNP products. MVP said working with Belong will provide New Yorkers with the depth of knowledge and experience needed to support underserved members with complex healthcare needs, such as multiple chronic conditions.

Patrick Foley, co-founder and CEO of Belong Health, said the company launched about a year and a half ago. “The goal for the company was to partner with health plans like MVP to launch dual special needs products that would be focused on beneficiaries who were eligible for both Medicare and Medicaid. These beneficiaries probably have a good amount of complex illnesses as well as vulnerable situations in terms of access to social services and things that contribute to them not being able to really maximize their health care,” he explained. . “We feel very lucky as both organizations realized very quickly that we were culturally and missionally aligned, and we are able to help MVP launch the dual special needs product in New York for 2022.”

Dominick Bizzarro, chief growth officer of MVP Health Care, said the company has been in Medicare Advantage for some time and as a regional health plan; it has also been part of Medicaid managed care for some time. “For us, looking at the dual special needs population, there was a real opportunity that I don’t think we had the right products for,” he said. “When you consider entering this market, you recognize the need for holistic care for the person and think of care in the context of people’s lives and the challenges they face beyond diagnosis, which is usually simple enough. A care plan must be delivered in the context of what that person is capable of doing. For us, as a very customer-centric organization, we were looking for a partner who shared values ​​with us and focused on the customer and their unmet needs. »

I asked Foley why it made sense to enter this space now. Have there been any regulatory changes that make it more attractive as a business opportunity?

“What we’ve realized is that the entire industry across the country just hasn’t kept pace in terms of offering dual plans for special needs,” he said. answered. “There has of course been a proliferation of Medicare Advantage plans. It was awesome. But there weren’t as many on the special needs side. It’s not just about the whole person, but if you really need to serve the whole community, you need to have a special needs dual product. When Belong Health launched, it wasn’t so much about recent changes at CMS, but rather an acknowledgment that this program has been underutilized.

New York and California are leading the way from a regulatory standpoint in pushing those states’ health plans to fully integrate Medicare and Medicaid, Foley added, “but we believe that over the next five years , many other states will do so. . It’s happening all over the country, and some states are just moving faster than others.

A press release from both organizations mentions that Belong has proprietary technology to optimize the management and delivery of care. I asked if Foley could elaborate on that.

Well, another alignment between Belong and MVP is that we both believe you look at customer relationship management, or CRM, and patient engagement as a holistic approach,” Foley said. “It’s not just something a customer service agent does; it’s also something a care manager does. Anyone who interacts with the recipient should maximize that. MVP and Belong are jointly developing a CRM-based platform. For those of us who have been in the healthcare industry for a while, it’s a bit of a pain because traditionally, healthcare companies use this very old technology. I mean, it’s probably 1970s technology, so we’re trying to take the most current CRM-based technology and not just create customer service workflows within a technology platform , but also care management workflows, and even workflows that deal with loops in the physician community as well.”

Belong, which is in talks to partner with other health plans and health systems, says it takes all the risk up and down with local health plans. “We think that’s a really important part of what makes this partnership is that when Dominick, myself and the other MVP leaders started the dialogue around the partnership, it was always based on a sharing complete 50/50 of everything that would be the upstream investments and then downstream what happens later,” Foley said. “We started a joint venture in New York State, and that company is dedicated to support the dual line of special needs activity that has been launched.”

Bizzarro told an anecdotal story as an example of how the program works. He described a gentleman named MP, who joined the D-SNP scheme. He receives an outreach call to register and understand any concerns he may have. The care manager learns that he has stopped taking his medication because it was difficult for him to get to the pharmacy to pick it up. He has several chronic illnesses, but he doesn’t have a lot of support around him, so he misses his medication. “Within two days of the call, his medication is delivered to him. Now he’s on his meds and he knows he has a team he can go to that really gets to know him and what the challenges are. Bizzaro said. “His diagnosis had been identified, but his care needs to be managed and coordinated.”

Although it’s still too early to talk about outcome data, Bizzarro said, “I can tell you that our team, especially the clinicians on our team, really feel that these disease management awareness activities care and commitment work, and when you look at the cost side, it’s all going in the right direction. We’re collecting really strong stories of where it’s working, and those are the main indicators that results are coming because you get a general idea of ​​whether things are moving in the right direction or not.

Foley noted that the pandemic created some early challenges with the launch of the new program. “We are on the right track to get where we want to get. I think some of the early numbers were affected by the pandemic,” he said. The federal health emergency allows members to simply stay where they are; they don’t have to get out of their Medicaid plan, so there are a lot of Medicaid members who are 66, 67, or 68. They would normally be transitioning to Medicare, he said, “but right now they’re not, so that’s an element. I think once we get past some of these issues Abnormal in the short term, things will go back to where we expected them to be.

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