Noteworthy News

Lessons in Serving Dual Eligibles

A new report examines the efforts of health plans to improve the delivery and coordination of care for dual eligibles: individuals covered by both Medicare and Medicaid.

This population has received growing attention from policy-makers, including the Centers for Medicare & Medicaid Services through its 2011 Financial Alignment Initiative that seeks to test new models of working with this difficult-to-serve population.

iStock_000008112453XSmallNow, the Center for Health Care Strategies has reviewed how 14 different health plans approached this challenge. It found that the plans generally:

  • supported individuals in the community by addressing housing and other social determinants of health and by reducing institutional care;
  • coordinated care delivery across providers and services;
  • identified unmet needs;
  • engaged providers across the continuum of care;
  • coordinated physical and behavioral health; and
  • explored alternative payment models.

The report also identified lessons learned based on the efforts of the 14 different approaches, including:

  • investing in relationships with states and providers was essential to success;
  • implementing extensive care management required significant time and resources; and
  • coordinating physical and behavioral health services required collaboration and information-sharing.

Because of where they are located, private urban safety-net hospitals generally serve far more dually eligible patients than the typical hospital.

To learn more about how the 14 different plans went about their work and what they learned along the way, go here to see the Center for Health Care Strategies report ACAP Medicare-Medicaid Plans and the Financial Alignment Demonstrations: Innovations and Lessons.

 

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