New England Consortium:
New Hampshire Dual Eligibility Initiative

Project Overview

New Hampshire's MMIP project was originally planned as a managed care model that would link acute care and long-term care together. As a result of the Balanced Budget Act, low AAPCC rates, and a pullout of managed care plans from the New Hampshire market, the concept of integration between Medicare and Medicaid as well between acute and long-term care had to be modified. For now the project focuses on redesigning the State's long term care system for elderly persons and persons with disabilities to promote greater coordination between primary/acute care and long term care supports.

In September of 2000, the New Hampshire Division of Elderly and Adult Services (DEAS) initiated a statewide strategic planning process for integrating long term care and chronic care, utilizing the technical assistance of Bailit Health Purchasing, LLC. The process began with an intensive self-assessment by the agency, focusing on its mandates, service population, external and internal stakeholders, its mission statement, and major accomplishments since its establishment in 1987. This examination showed that the DEAS had expanded its programs and service populations and that its mission statement needed to change to align its service philosophy more closely with concepts such as consumer direction. Consequently, DEAS revised its mission statement and crafted a vision statement for the ideal system of long term supports for elderly and disabled persons.

The next phase of the process involved an extensive public dialog with consumers, families, caregivers, providers, advocates, and State legislators. DEAS presented ten regional overviews of the long term supports vision statement and its revised mission statement to these stakeholders and asked for their comments. At these sessions, participants were encouraged to "stay with the process" because the agency would continue to seek their input throughout. This process is intended to be collaborative and cooperative, using the comments gathered in this dialog to identify service gaps and barriers as well as strengths in the current system. These comments will be used to frame recommendations for long term care systems change.

DEAS has recently completed fifteen regional "town meetings" on long term care throughout New Hampshire in which consumers and families were encouraged to speak about their experiences in finding and using long term supports and to recommend ways to improve service delivery. Commentary from these meetings will be collated, summarized, and shared in the next phase of public review. DEAS has also surveyed long term care consumers and their caregivers, both family and professional, in Belknap County to gather their input on service delivery. The remaining nine counties will be surveyed.

Other components of this project include a linked data analysis of Medicare and Medicaid utilization data through a contract with Dartmouth College. PilotHealth of Cheshire County is currently conducting a survey of acute and primary care providers in the Monadnock Region to determine to what extent coordination between primary/acute care and long term care exists and how it can be strengthened.

Next Steps

• Identify current barriers in the delivery system to the use of all services and the effective integration of supports through consumer surveys from each county.
• Compile and analyze data from consumer studies, regional "town meetings, and PilotHealth study and develop recommendations.
• Develop recommendations for systems and operational changes to eliminate or minimize barriers to care and effective service integration; disseminate recommendations.
• Develop methodology and work plan for assessing the effectiveness and success of changes to the delivery system and DEAS operations.

Contact Information

Mary Maggioncalda
New Hampshire Division of Elderly and Adult Services
129 Pleasant Street
Concord, NH 03301
Phone: 603-271-4410
Fax: 603-271-4643
Email: mmaggion@dhhs.state.nh.us
Website: http://www.dhhs.state.nh.us/