statue of liberty with NYC in the background

In theory, the New York State Fully Integrated Duals Advantage Program, or FIDA, integrates care, enhances access, and streamlines coverage. In reality, this ambitious initiative has experienced low enrollment and a high opt-out rate in its first year. And its shaky start has prompted five health insurers to stop offering plans for it in 2016.

The numbers aren’t positive. As of November 2, about 7,300 people were enrolled out of 80,000 to 100,000 projected by the state’s Department of Health. And nearly 60,000 eligible individuals have opted out.

The state-federal initiative, approved by the Centers for Medicare and Medicaid Services in 2013, is a demonstration program that is enrolling downstate New Yorkers—low-income elderly or disabled persons—who qualify for both Medicare and Medicaid in a managed long-term care plan. This demographic typically has high medical costs and is poorly managed. New York and a handful of other states, including California and Massachusetts, stepped up to implement the plan because of its potential. The California and Massachusetts demonstrations have had similar struggles.

Participants have a single insurance plan to cover all medical care instead of dealing with two payers; no premiums, deductibles or co-pays; and a care manager who coordinates doctor appointments and medications. Beneficiaries are receiving targeted care designed to improve health and reduce costs, duplication of services, and avoidable hospitalizations.

Despite the program’s potential, the initiative simply hasn’t caught on yet. Why not? Couple of reasons. First, expectations may have simply been too high for an initiative like this that will take years to build. But the bigger issue is lack of communication and education to these eligible individuals and physicians:

  • Beneficiaries did not get enough information on why they should switch plans.
  • Nearly 60,000 people opted out because they worried about losing coverage for drugs and their preferred doctors.
  • Physicians did not understand the program, and instead of encouraging enrollment, some told their patients to opt-out. There also is no incentive for physicians to embrace the initiative.

What’s next? State officials have admitted to some mistakes and promise a renewed marketing and outreach push to enroll eligible individuals into the program. The state is also proposing participation incentives to physicians. And state officials asked the federal government to extend the program through 2019 instead of 2017 to give this program a real chance at success. Each participating state has done the same so this program is moving ahead—growing pains and all.

New York is even going a step further by implementing a new FIDA program for individuals with intellectual and developmental disabilities in New York City, Long Island, and Rockland and Westchester counties in 2016. Care will focus on these individuals’ long-term care needs and includes a benefits package tailored for this population.

While FIDA has had a rough start, those enrolled in the program have regarded it positively and are sticking with it. Success isn’t going to happen in a year or even two years. But this program is designed to give them better care, more access, less duplication of services, and simply a better healthcare experience. And it’s got support at the state and federal levels, which is hard to come by.

Remember when health insurers started pushing high deductible plans to employer groups and how poorly that was received? Now it’s common place in health plan offerings. Or how challenging it has been to educate consumers on how to use public health insurance exchanges? Enrollment in many state exchanges is now exceeding expectations. A decade ago a patient-centered medical home wasn’t even heard of, and now if a physician practice doesn’t hold the designation, consumers may hesitate to go there. Healthcare is evolving faster than I can type this blog, and that’s not going to change. A few growing pains can, and often do, lead to improvement. Targeted education, outreach, and a little success from change will go a long way in navigating this strange new healthcare world.

The state remains committed to FIDA and says it is taking steps to right the ship. Dual-eligibles and physicians may be wise to give the program a second look.

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