The Member/Participant Advisory Council benefits participants in both of our plans by giving members a voice and a chance to influence the direction of ICS.
Any ICS member or caregiver can go to these roughly bi-monthly meetings. At the last Council meeting at ICS’s Bronx office on June 29, ICS President Rick Surpin and Chief Operating Officer Regina Estela were on hand for members to ask questions about policy, make suggestions on how to improve services, and get direct feedback from ICS’s top leadership.
Rick and Regina were also at the meeting to make a pitch for members to take a second look at the younger of our two plans, ICS Community Care Plus FIDA-MMP, which is part of a multi-year demonstration program to coordinate the care of people who are eligible for both Medicaid and Medicare. “We want to make the FIDA program work for you and for us,” Rick said.
FIDA stands for Fully Integrated Duals Advantage; it’s designed to be a single—i.e., integrated—plan that coordinates the care and payment of Medicaid and Medicare services, which traditionally have operated in two separate spheres, for those who are covered by both. (MMP stands for “Medicare-Medicaid plan.”) Dual eligibles often have multiple cards for multiple health care services—one for Medicaid, one for Medicare Advantage, one for Medicare Part D—each with different rules. FIDA is intended to eliminate that clutter, to put all of a participants’ health care needs—primary care, urgent care, hospitalization, home health care, skilled nursing, rehab, durable medical equipment (DME), dental and vision, medications—under a single payer system.
New and Improved FIDA
The theory behind FIDA is golden; in practice, it hasn’t always shone as expected. But, as Rick and Regina explained to members at the Council meeting, ICS is committed to making FIDA produce better health care outcomes. “The policy people want members to move into an integrated plan,” Regina explained at the Council meeting. “ICS wants to encourage people to move into FIDA.”
Launched in January 2015, the ICS FIDA plan struggled in its first year to retain participants. Many found the state’s passive enrollment process confusing. The few providers who had heard of FIDA were put off by its requirement that they participate in semi-annual interdisciplinary team (IDT) meetings. Many FIDA members were told their primary care physicians were not in the plan, often because their doctors did not know the health care organizations they belonged to, in fact, were in the plan.
By January of this year, the state had heard enough feedback from participants, providers and plans to know that for FIDA to work, some tweaks were in order. With changes to the plan that make it easier for all to use, FIDA participants are now in a better position to have all of their services covered under one plan.
Reasons to Switch
So how has the plan improved? Why, indeed, switch to FIDA now?
- Start with coordinated care under a single plan—the basic idea of FIDA has not changed. Put simply, with FIDA, you need just one card to see your primary care doctor or specialist, to get dental care, to have an eye exam, to get medications, to get urgent care or enter the hospital.
- Coordinated care means your primary care doctor, specialists, rehab clinicians and technicians, behavioral health provider, etc., will be more aware of what everyone else is doing on your behalf, and that means better care for you.
- The wheelchair and DME ordering and servicing process is streamlined and faster.
- You have no out-of-pocket fees: no co-pays for services in network, no co-pays for covered medications or supplies.
- The IDT is simpler than before. Your primary care physician is no longer required to be at every meeting. IDT meetings can now consist of just you and your ICS care manager. Because of this simplified IDT structure, you are more empowered. You have greater say in and control over your six-month care plan.
- Your doctor is probably already in our network, and if he or she is not, it’s easy to join. You are still covered for visits with them for 90 days while they are being added to the network.
- ICS has created a special FIDA team dedicated to making the plan work for participants. Care managers on the Team are experts in FIDA, and because of that, satisfaction among participants has grown.
If you’re a satisfied member of ICS’s other plan, ICS Community Care MLTC, no worries. But if you or an ICS member you know might benefit from joining FIDA, there’s no better time to make the switch.