State and federal agencies are aggressively exploring integrated payment and delivery models needed to raise healthcare quality and lower costs for people eligible for both Medicare and Medicaid. The nation’s dual eligibles are overwhelmingly low income, elderly, and among the most costly to treat.
The Care Continuum Alliance (CCA) notes that in Medicare, 21 percent of enrollees are dually eligible but account for 36 percent of spending and in Medicaid, 15 percent are dually eligible and account for 39 percent of spending so it is paramount that the healthcare system needs to provide integrated and coordinated care to really address the cost issues. Although, dual eligibles at the intersection of Medicaid and Medicare, are a relatively small group consisting of 8 or 9 million people.
“Dual eligibles are among the most challenging populations for Medicaid and Medicare, due to the high incidence of multiple chronic conditions, socioeconomic disparities, and limited coordination between the programs,” CCA President and CEO Tracey Moorhead said.
CCA representing more than 200 organizations and individuals has identified core program components necessary for operating comprehensive integrated dual eligible delivery models. These specific issues are discussed in-depth in their just released Policy Paper “Designing and Deploying Core Components of Integrated Dual Eligible Models”.
On March 1, 2012, CCA sponsored a Capitol Hill briefing to discuss the challenges and the solutions to the problem as reported in their Policy Paper. Representative Bill Cassidy (R-LA) opened the briefing commenting that the present system in the U.S provides dual eligibles with very expensive but at the same time, poor care and in addition, payment incentives are pulling the system in all different directions.
As Richard Fredrickson, Vice President for SSI and LTC Programs at Centene Corp, and a speaker at the briefing pointed out, duals are not a homogenous population and are not all eligible for the same level of care. In fact, 75 percent of Nursing Home eligibles live in the community resulting in significant long term savings in Medicaid spending.
Matt Salo, Executive Director, of the National Association of Medicaid Directors who reported that we need to find solutions to providing care to duals since they consume forty percent of Medicaid funds.
Jerome Vaccaro, M.D. President & COO at APS Healthcare is insistent that an integrated transparent system of care and services is an important part of the solution, and Pam Coleman, Senior Vice President for Government Programs at INSPIRIS a provider-based chronic care management company, wants to see coordinated person-centered care so that patients can receive in-home primary care and care management.
The CCA Policy Paper recommends core solutions such as the need for:
• Centralized, comprehensive, and interconnected data
• Health risk assessments and stratification
• Population-specific and personalized care planning
• Care coordination and transitions of care
• Education, training and incentives for patients and providers
• Program evaluation and outcomes toward improvements
To download the policy paper, go to www.carecontinuum.org.