Noteworthy News

Challenges In Determining Effectiveness of Dual-Eligible Programs

The federal government is encountering challenges in evaluating the effectiveness of programs designed to serve low-income elderly patients served by both Medicare and Medicaid – patients known as dual-eligibles.

Or so concludes the U.S. Government Accountability Office in a new report.

With the dually eligible accounting for 35 percent of total Medicare and Medicaid expenditures, the Centers for Medicare & Medicaid Services’ “Financial Alignment Initiative” has worked to find new and better ways to care for such individuals. Such efforts have been plagued, however, by challenges in locating such individuals at times because they are often part of a transient population. In addition, the GAO review, which examined programs in the first five states to launch such initiatives – California, Illinois, Massachusetts, Virginia, and Washington – found that the data reported by the individual states often differed, making it difficult to compare both different approaches to serving the dual-eligible population and overall program results.

gaoFinding new and better ways to care for dual-eligibles is especially important for non-profit urban safety-net hospitals because such providers care for especially large numbers of low-income seniors.

The GAO has recommended that CMS develop new comparable data measures and better align the program’s existing methodologies.

To learn more about early experiments in serving the dual-eligible population, go here to see the GAO report Medicare and Medicaid: Additional Oversight Needed of CMS’s Demonstration to Coordinate the Care of Dual-Eligible Beneficiaries.

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